1,914,991 research outputs found
Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.
Full text linkOBJECTIVE: Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock.
METHODS: The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575-590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit ? (2) Should we monitor preload and fluid responsiveness in shock ? (3) How and when should we monitor stroke volume or cardiac output in shock ? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock ? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock ? Four types of statements were used: definition, recommendation, best practice and statement of fact.
RESULTS: Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring.
CONCLUSIONS: This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock
Hyperglycemia in the Intensive Care Unit
No full textHyperglycemia is frequently encountered in the intensive care unit. In this disease, after severe injury and during diabetes mellitus homeostasis is impaired; hyperglycemia, hypoglycemia and glycemic variability may ensue. These three states have been shown to independently increase mortality and morbidity. Patients with diabetics admitted to the intensive care unit tolerate higher blood glucose values without increase of mortality. Stress hyperglycemia may occur in patients with or without diabetes and has a strong association with increased mortality in the intensive care unit patients. Insulin is the drug of choice to treat hyperglycemia in the intensive care unit. In patients with moderate hyperglycemia a basal–bolus insulin concept can be used. Close glucose monitoring is of paramount importance throughout the intensive care unit stay of the patient. In the guidelines for glycemic control based on meta-analyses it was shown that a tight glycemic control does not have a significant mortality advantage over conventional treatment. Given the controversy about optimal blood glucose goals in the intensive care unit setting, it seems reasonable to target a blood glucose level around 140 mg/dL to avoid episodes of hypoglycemia and minimize glycemic variability. The closed loop system with continuous glucose monitoring and algorithm based insulin application by an infusion pump is a promising new concept with the potential to further reduce mortality and morbidity due to hyperglycemia, hypoglycemia and glycemic variability. The goal of this review was to give a brief overview about pathophysiology of hyperglycemia and to summarize current guidelines for glycemic control in critically ill patients
Intensive Care Management in Pediatric Burn Patients
No full textBurn injury is still a leading cause of morbidity and mortality in children. This article aimed to review the current principles of management from initial assessment to early management and intensive care for pediatric burn patients. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 62-9
Benefitting From Monitorization in Intensive Care Unit
No full textThe most essential matter about following a patient in intensive care unit is a fine and correct monitorization. While benefitting from monitorization is the main objective of every intensive care physician, it should be discussed how successful we are when we do not take monitorization as a subject of interest sufficiently. This physicians who are both performing medical care and education has a very important role regarding the matter: To question and confirm the correctness of the parameters that are being followed and to use this data for choosing the treatment type. The vital parameters that are found necessary to be followed usually do not present us the sufficient utility. For purpose, implementing monitorization in a way of whole perspective including Examining, Questioning, Reading (Observing), Repeating, Recalling will maintain to receive consequences for the benefit of the patient. (Journal of the Turkish Society Intensive Care 2011; 9: 110-5
Nationale Intensive Care Evaluatie
No full textDe Nationale Intensive Care Evaluatie (NICE) verzorgt de continue en complete registratie van alle beschikbare data van deelnemende IC afdelingen, met als doel het monitoren en optimaliseren van de kwaliteit van IC zorg.
De Minimale Data Set (MDS) is de kernregistratie van de stichting NICE en bevat zo’n 90 variabelen waarmee de demografie, de opname- en ontslaggegevens, fysiologie, de redenen van opname en de ernst van ziekte in de eerste 24 uur van IC opname alsmede de uitkomstmaten IC- en ziekenhuissterfte en behandelduur beschreven worden. Alle NICE-deelnemers verzamelen van al hun IC-opnamen tenminste deze gegevens. Voor het beschrijven van de ernst van ziekte en de case-mix gecorrigeerde sterfte wordt gebruik gemaakt van een aantal prognostische modellen zoals APACHE IV en SAPS II. Door middel van een koppeling met de Vektis database wordt ook inzicht verkregen in de lange termijn uitkomsten van de IC-patiënten.
Sinds de start van de registratie in 1996 zijn enkele aanvullende registraties toegevoegd aan de MDS: de Sequential Organ Failure Assessment (SOFA) module waarin per dag het functioneren van verschillende orgaansystemen worden geregistreerd, de kwaliteitsindicatoren (KIIC-module) waarin naast de IC-capaciteit per dag (aantal IC verpleegkundigen en operationele IC-bedden) ook alle beademingsperioden en gemeten glucosewaarden van de opgenomen IC-patiënten worden geregistreerd , de complicatieregistratie module waarin per behandeldag wordt aangegeven of en welke complicatie tijdens de behandeling heeft plaatsgevonden, de sepsisregistratie module waarin de behandeling van ernstige sepsis patiënten in kaart wordt gebracht, de verpleegkundige capaciteitsregistratie waarin de zorgbehoefte van de patiënt en daarmee ook de werklast van de IC verpleegkundige wordt geregistreerd en de NICE2Improve actiegerichte indicatoren met data op het gebied van pijnmanagement en beademing. NICE2Improve zal verder uitgebreid worden met data op het gebied van antibiotica, bloedtransfusies, delier (verwardheid) en decubitus (doorligwonden).
Vanwege de COVID-19 pandemie is NICE in 2020 uitgebreid met de COVID-19 registratie waarin basis gegevens zoals geboortedatum, opname en ontslagdatum, COVID-status (verdacht, lab of bewezen, negatief), reden van opname (COVID-19 is de belangrijkste reden; COVID-19 is één van de redenen; COVID-19 is niet de opnamereden) en sterfte van alle opgenomen COVID-19 patiënten wordt geregistreerd
Identifying Priorities in Intensive Care : a description of a system for collecting intensive care data, an analysis of the data collected, a critique of aspects of severity scoring systems used to compare intensive care outcome, identification of priorities in intensive care and proposals to improve outcome for intensive care patients.
No full textMDThis thesis reviews the requirements for intensive care audit data and describes the
development of ICARUS (Intensive Care Audit and Resource Utilisation System), a
system to collect and analyse intensive care audit information. By the end of 1998
ICARUS contained information on over 45,000 intensive care admissions. A study
was performed to determine the accuracy of the data collection and entry in ICARUS.
The data in ICARUS was used to investigate some limitations of the APACHE II
severity scoring system. The studies examined the effect of changes in physiological
values and post-intensive care deaths, and the effect of casemix adjustment on
mortality predicted by APACHE II. A hypothesis is presented that excess intensive
care mortality in the United Kingdom may be concealed by intensive care mortality
prediction models. A critical analysis of ICARUS data was undertaken to identify
patient groups most likely to benefit from intensive care.
This analysis revealed a high mortality in critically ill patients admitted from the
wards to the intensive care unit. To help identify critically ill ward patients, the
physiological values and procedures in the 24 hours before intensive care admission
from the ward were recorded: examination of the results suggested that management
of these patients could be improved. This led to the setting up of a patient at risk team
(PART). Two studies report the effect of the PART on patients on the wards and on
the patients admitted from the wards to the intensive care unit. Additional care for
surgical patients on the wards is suggested as a way of improving the management of
high-risk postoperative patients. The thesis concludes by discussing the benefits of
the ICARUS system and speculating on the direction that should be taken for
intensive care audit in the future
Fast Hugs with Intensive Care Unit
No full textMnemonics are commonly used in medical procedures as cognitive aids to guide clinicians all over the world. The mnemonic ‘FAST HUG’ (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glycemic control) was proposed almost ten years ago for patient care in intensive care units and have been commonly used worldwide. Beside this, new mnemonics were also determined for improving routine care of the critically ill patients. But none of this was accepted as much as “FAST HUGS”. In our clinical practice we delivered an another mnemonic as FAST HUGS with ICU (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, Stress ulcer prevention, and Glucose control, Water balance, Investigation and Results, Therapy, Hypo-hyper delirium, Invasive devices, Check the daily infection parameters, Use a checklist) for checking some of the key aspects in the general care of intensive care patients. In this review we summarized these mnemonics
Use of Echocardiography in The Intensive Care Unit
No full textEchocardiography is a diagnosis and research method that allows us to learn about anatomical and mechanical functions of the heart by using ultrasonic sound waves. Echocardiography is rapid and non-invasive way to image the cardiac structures in intensive care unit. Preload, myocardial and ventricular functions, valve diseases and vegetations, cardiac tamponade, pulmonary embolism, aortic dissection, and cardiac arrest can be investigated with echocardiography in intensive care unite. Indications for echocardiography, views of the main pathologies encountered in intensive care unite, commonly used windows in echocardiography are included in this article. (Journal of the Turkish Society Intensive Care 2012; 10: 28-36
Predicting death and readmission after intensive care discharge
Full text linkBackground: Despite initial recovery from critical illness, many patients deteriorate after discharge from the intensive care unit (ICU). We examined prospectively collected data in an attempt to identify patients at risk of readmission or death after intensive care discharge. Methods: This was a secondary analysis of clinical audit data from patients discharged alive from a mixed medical and surgical (non-cardiac) ICU. Results: Four hundred and seventy-five patients (11.2%) died in hospital after discharge from the ICU. Increasing age, time in hospital before intensive care admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and discharge Therapeutic Intervention Scoring System (TISS) score were independent risk factors for death after intensive care discharge. Three hundred and eighty-five patients (8.8%) were readmitted to intensive care during the same hospital admission. Increasing age, time in hospital before intensive care, APACHE II score, and discharge to a high dependency unit were independent risk factors for readmission. One hundred and forty-three patients (3.3%) were readmitted within 48 h of intensive care discharge. APACHE II scores and discharge to a high dependency or other ICU were independent risk factors for early readmission. The overall discriminant ability of our models was moderate with only marginal benefit over the APACHE II scores alone. Conclusions: We identified risk factors associated with death and readmission to intensive care. It was not possible to produce a definitive model based on these risk factors for predicting death or readmission in an individual patient.Not peer reviewedAuthor versio
The Concept of Ethics in the Intensive Care
No full textThe concept of ethics in the intensive care unit has developed in the last 50 years along with the advancements and regulations in this area of medicine. Especially by the use of life-supportive equipment in the intensive care units and the resulting elongation in the terminal stage of life has led to newly described clinical conditions. These conditions include vegetative state, brain death, dissociated heart death. The current trend aiming to provide the best health care facilities with optimal costs resulted with regulations. The conflicts in the patient-physician relations resulting from these regulations has resolved to some extent by the studies of intensive care unit ethics. The major ethical topics in the intensive care are the usage of autonomy right, the selection of patients to be admitted to the intensive care unit and the limitation of the treatment. The patient selection is optimized by triage and allocation, the limitation of the treatment is done by the means of withdrawal and withhold, and the usage of autonomy right is tried to be solved by proxy, living will and ethics committee regulations. The ethical regulations have found partial solutions to the conflicts. For the ultimate solution much work about the subject has to be done. (Journal of the Turkish Society of Intensive Care 2010; 8: 77-84
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