Tag: ICU

Why is trauma activation so expensive?

I can understand hospitals charging a fee for trauma activations to help recover some of the costs of having a trauma service. The staff may require some special training. Managing the service, collecting data, and other... read more

Trach Travails: Need-to-Know ED Tricks for Airway Emergencies in Tracheostomy Patients

The outside hospital emergency physician passed a bougie through the patient’s existing metal trach and exchanged the metal trach for a 6-0 endotracheal tube. After the exchange, the ETT cuff was inflated, and the patient... read more

ICU ventilators overused among advanced-dementia patients

Mechanical ventilation may be lifesaving, but in certain patient cases it may prolong suffering without a clear benefit. JAMA Internal Medicine published a study of 635,008 hospitalizations of nursing-home patients with advanced... read more

Positive End-Expiratory Pressure Lower Than the ARDS Network Protocol Is Associated with Higher Pediatric ARDS Mortality

Patients with PARDS managed with lower PEEP relative to FiO2 than recommended by the ARDSNet model had higher mortality. Clinical trials targeting PEEP management in PARDS are needed. This was a multicenter, retrospective... read more

Sodium Bicarbonate Therapy for Patients with Severe Metabolic Acidaemia in the ICU

In patients with severe metabolic acidaemia, sodium bicarbonate had no effect on the primary composite outcome. However, sodium bicarbonate decreased the primary composite outcome and day 28 mortality in the a-priori defined... read more

Modes of Mechanical Ventilation Vary Between Hospitals and ICUs within a University Healthcare System

As evidence-based guidance to aid clinicians with mechanical ventilation mode selection is scant, we sought to characterize the epidemiology thereof within a university healthcare system and hypothesized that nonconforming... read more

Flexible Versus Restrictive Visiting Policies in ICUs

Flexible ICU visiting hours have the potential to reduce delirium and anxiety symptoms among patients and to improve family members' satisfaction. However, they may be associated with an increased risk of burnout among ICU... read more

Hospitalists Are the New Intensivists

Intensivists may get all the credit, but over 37,000 hospitalists provide much of the care for ICU patients in the U.S. According to a recent survey, they often do it without the presence or availability of intensivists for... read more

Increasing the Number of Medical Emergency Calls Does Not Improve Hospital Mortality

With adjustment for patient factors, illness, and comorbidities, increased emergency calling rates were not associated with reduced in-hospital mortality. Efforts to increase calling rates do not seem warranted. We studied... read more

Health-related Outcomes of Critically Ill Patients With and Without Sepsis

Critically ill patients with sepsis have higher healthcare resource use and costs but similar survival and HRQoL compared to matched patients without sepsis. We conducted a primary propensity score matched analysis of patients... read more

Treatment of Acute Non-Anion Gap Metabolic Acidosis

Acute non-anion gap metabolic acidosis is now recognized to be as a common cause of metabolic acidosis, particularly in the ICU. Further examination of its impact on cellular function and clinical outcome are needed. Most... read more

Evaluation of a strategy for enrolling the families of critically ill patients in research using limited human resources

Family members were recruited for more than one third of eligible patients, and >90% of approached consented to participate. There are important demographic differences between patients with vs without an enrolled family... read more

Collective Quality Improvement in the Pediatric Cardiology Acute Care Unit

Collaborative quality improvement and learning networks have amended healthcare quality and value across specialities. Motivated by these successes, the Pediatric Acute Care Cardiology Collaborative (PAC3) was founded in... read more

Survival outcomes after prolonged ICU length of stay among trauma patients: The evidence for never giving up

Prolonged intensive care unit length of stay (ICU-LOS) is associated with high mortality for medical and surgical patients. Existing literature suggests that this may not be true for trauma patients.The results reveal that... read more

Peer Support in Critical Care

Peer support appeared to reduce psychologic morbidity and increase social support. The evidence for peer support in critically ill populations is limited. There is a need for well-designed and rigorously reported research... read more

The Impact of Enhanced Critical Care Training and 24/7 (Tele‐ICU) Support on Medicare Spending and Postdischarge Utilization Patterns

Innovations in workforce training and technology specific to the ICU may be useful in addressing the shortage of intensivist physicians, yielding benefits to patients and payers. Implementation of the advanced practice provider... read more

The Value of 24/7 In-House ICU Staffing 24/7 Intensivist in the ICU

Staffing of high-volume, high-intensity ICUs with 24 × 7 intensivist coverage facilitates the system changes, which allow ICU teams to provide 24 × 7 critical care.... read more

Beyond Bleeps and Alarms: Live Music by the Bedside in the ICU

Live music by the bedside is an additional, simple and inexpensive factor in the open ICU, aiming at reducing the incidence of delirium and transform the critical care setting into a more familiar and domestic environment.... read more

Acute Skeletal Muscle Wasting in Critical Illness

Among these critically ill patients, muscle wasting occurred early and rapidly during the first week of critical illness and was more severe among those with multiorgan failure compared with single organ failure. These findings... read more

Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features

Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features: A multicenter study in southern Brazil. The main objective is to evaluate the incidence and risk factors of pressure ulcers (PU) in adult... read more

Antibiotic Decisions in the ICU: A Dragon’s Tale

Medical decision-making about antibiotic use in critically ill patients is challenging and complex. The need for antibiotic stewardship requires judicious prescription and choice of antimicrobials, as the need for effective... read more

Practice Change From Intermittent Medication Boluses to Bolusing From a Continuous Infusion in Pediatric Critical Care

Implementation of bolus medications from continuous infusion in PICUs significantly decreased time to begin a bolus dose and increased nursing satisfaction. The practice change also improved medication utilization without... read more