scholarly journals Equipment-related Electrocardiographic Artifacts

2008 ◽  
Vol 108 (1) ◽  
pp. 138-148 ◽  
Author(s):  
Santosh I. Patel ◽  
Michael J. Souter ◽  
David S. Warner ◽  
Mark A. Warner
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Setting ◽  
Clinical Signs ◽  
Basic Principles ◽  
Therapeutic Modalities ◽  
Iatrogenic Complication ◽  
Electrical Devices ◽  
External Sources ◽  
Artifactual Changes

Interference of the monitored or recorded electrocardiogram is common within operating room and intensive care unit environments. Artifactual signals, which corrupt the normal cardiac signal, may arise from internal or external sources. Electrical devices used in the clinical setting can induce artifacts by various different mechanisms. Newer diagnostic and therapeutic modalities may generate artifactual changes. These artifacts may be nonspecific or may resemble serious arrhythmia. Clinical signs, along with monitored waveforms from other simultaneously monitored parameters, may provide the clues to differentiate artifacts from true changes on the electrocardiogram. Simple measures, such as proper attention to basic principles of electrocardiographic measurement, can eliminate some artifacts. However, in persistent cases, expert help may be required to identify the precise source and minimize interference on the electrocardiogram. Technological advancements in processing the electrocardiographic signal may be useful to detect and eliminate artifacts. Ultimately, an improved understanding of the artifacts generated by equipment, and their identifying characteristics, is important to avoid misinterpretation, misdiagnosis, and iatrogenic complication.

Fever and Leukocytosis in Critically Ill Trauma Patients: It is Not the Blood

2009 ◽  
Vol 75 (5) ◽  
pp. 405-410 ◽  
Author(s):  
Jeffrey A. Claridge ◽  
Joseph F. Golob ◽  
Adam M. A. Fadlalla ◽  
Mark A. Malangoni ◽  
Jeffrey Blatnik ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Injury Severity ◽  
Leukocyte Count ◽  
Cohort Analysis ◽  
Clinical Signs ◽  
Blood Cultures ◽  
Daily Temperature ◽  
Trauma Patients

The diagnosis of bacteremia in critically ill patients is classically based on fever and/or leukocytosis. The objectives of this study were to determine 1) if our intensive care unit obtains blood cultures based on fever and/or leukocytosis over the initial 14 days of hospitalization after trauma; and 2) the efficacy of this diagnostic workup. An 18-month retrospective cohort analysis was performed on consecutively admitted trauma patients. Data collected included demographics, injuries, and the first 14 days maximal daily temperature, leukocyte count, and results of blood and catheter tip cultures. Fever was defined as a maximum daily temperature of 38.5°C or greater and leukocytosis as a leukocyte count 12,000/mm3 or greater of blood. Five hundred ten patients were evaluated for a total of 3,839 patient-days. The mean age and injury severity score were 49 ± 1 years and 19 ± 1, respectively. Four hundred twenty-five blood culture episodes were obtained and 25 (6%) bacteremias were identified in 23 patients (5%). A significant association was found between obtaining blood cultures in patients with fever (relative risk [RR], 7.7), leukocytosis (RR, 1.3), and fever + leukocytosis (RR, 3.2). However, no significant association was found between these clinical signs and the diagnosis of bacteremia. In fact, fever alone was inversely associated with bacteremia. Our intensive care unit follows the common “fever workup” practice and obtains blood cultures based on the presence of fever and leukocytosis. However, fever and leukocytosis were not associated with bacteremia, suggesting inefficiency and that other factors are more important after trauma.

scholarly journals Efficacy and safety of dexmedetomidine for prevention of withdrawal syndrome in the pediatric intensive care unit: protocol for an adaptive, multicenter, randomized, double-blind, placebo-controlled, non-profit clinical trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Maria Cristina Mondardini ◽  
Francesca Sperotto ◽  
Marco Daverio ◽  
Fabio Caramelli ◽  
Dario Gregori ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Withdrawal Syndrome ◽  
Clinical Signs ◽  
Pediatric Intensive Care ◽  
University Hospital ◽  
Prolonged Treatment ◽  
Double Blind ◽  
Double Blind Placebo

Abstract Background Prolonged treatment with analgesic and sedative drugs in the pediatric intensive care unit (PICU) may lead to undesirable effects such as dependence and tolerance. Moreover, during analgosedation weaning, patients may develop clinical signs of withdrawal, known as withdrawal syndrome (WS). Some studies indicate that dexmedetomidine, a selective α2-adrenoceptor agonist, may be useful to prevent WS, but no clear evidence supports these data. The aims of the present study are to evaluate the efficacy of dexmedetomidine in reducing the occurrence of WS during analgosedation weaning, and to clearly assess its safety. Methods We will perform an adaptive, multicenter, randomized, double-blind, placebo-controlled trial. Patients aged < 18 years receiving continuous intravenous analgosedation treatment for at least 5 days and presenting with clinical conditions that allow analgosedation weaning will be randomly assigned to treatment A (dexmedetomidine) or treatment B (placebo). The treatment will be started 24 h before the analgosedation weaning at 0.4 μg/kg/h, increased by 0.2 μg/kg/h per hour up to 0.8 μg/kg/h (neonate: 0.2 μg/kg/h, increased by 0.1 μg/kg/h per hour up to 0.4 μg/kg/h) and continued throughout the whole weaning time. The primary endpoint is the efficacy of the treatment, defined by the reduction in the WS rate among patients treated with dexmedetomidine compared with patients treated with placebo. Safety will be assessed by collecting any potentially related adverse event. The sample size assuring a power of 90% is 77 patients for each group (total N = 154 patients). The study was approved by the Ethics Committee of the University-Hospital S.Orsola-Malpighi of Bologna on 22 March 2017. Discussion The present trial will allow us to clearly assess the efficacy of dexmedetomidine in reducing the occurrence of WS during weaning from analgosedation drugs. In addition, the study will provide a unique insight into the safety profile of dexmedetomidine. Trial registration ClinicalTrials.gov, NCT03645603. Registered on 24 August 2018. EudraCT, 2015–002114-80. Retrospectively registered on 2 January 2019.

scholarly journals Efficacy and safety of Dexmedetomidine for prevention of withdrawal syndrome in Pediatric Intensive Care Unit: protocol for an adaptive, multicenter, randomized, double blind, placebo-controlled, non-profit clinical trial

2019 ◽  
Author(s):  
Maria Cristina Mondardini ◽  
Francesca Sperotto ◽  
Marco Daverio ◽  
Fabio Caramelli ◽  
Dario Gregori ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Withdrawal Syndrome ◽  
Clinical Signs ◽  
Pediatric Intensive Care ◽  
University Hospital ◽  
Prolonged Treatment ◽  
Double Blind ◽  
Double Blind Placebo

Abstract Background: Prolonged treatment with analgesic and sedative drugs in Pediatric Intensive Care Unit (PICU) may lead to undesirable effects as dependence and tolerance. Moreover, during the analgosedation weaning patients may develop clinical signs of withdrawal, known as withdrawal syndrome (WS). Some studies indicated that dexmedetomidine, a selective α2-adrenoceptors agonist, may be useful to prevent WS, but no clear evidences support this data. Aims of the present study are to evaluate the efficacy of dexmedetomidine in reducing the occurrence of WS during the analgosedation weaning, and to clearly assess its safety. Methods: We will perform an adaptive, multicenter, randomized, double-blind, placebo-controlled trial. Patients <18 years receiving a continuous intravenous analgosedation treatment for at least 5 days and presenting with clinical conditions that allows the analgosedation weaning will be randomly assigned to treatment A (dexmedetomidine) or treatment B (placebo). The treatment will be started 24 hours before the analgosedation-weaning at 0.4 mcg/kg/h, increased of 0.2 mcg/kg/h per hour up to 0.8 mcg/Kg/h (neonate: 0.2 mcg/Kg/h, increased of 0.1 mcg/Kg/h per hour up to 0.4 mcg/Kg/h)and continued throughout the whole weaning-time. The primary endpoint is the efficacy of the treatment, defined by the reduction in WS rate among patients treated with dexmedetomidine comparing with patients treated with placebo. Safety will be assessed collecting any potentially-related adverse event. The sample size assuring a power of 90% is 77 patients for each group (N total=154 patients). The study was approved by the Ethics Committee of the University-Hospital S.Orsola-Malpighi of Bologna on 22 March 2017. Discussion: The present trial will allow to clearly assess the efficacy of dexmedetomidine in reducing the occurrence of WS during the weaning of analgosedation drugs. In addition, the study will provide a unique insight into the safety profile of dexmedetomidine. Trial registration: AIFA ID TIP-15-01.ClinicalTrials.govID NCT03645603, registered on 24 August 2018. Retrospectively registered on EudraCT with ID 2015-002114-80 on 2 Jan 2019.

scholarly journals Relationship of serum procalcitonin levels and c-reactive protein levels in newborns with sepsis in different types of respiratory support in intensive care unit

2021 ◽  
Vol 13 (1) ◽  
pp. 39-47
Author(s):  
Aspazija Sofijanova ◽  
Sonja Bojadzieva ◽  
Silvana Naunova- Timovska ◽  
Hristina Mandzukovska ◽  
Elizabeta Shuperliska ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Statistical Analysis ◽  
Clinical Signs ◽  
Severe Infection ◽  
Predictive Values ◽  
Mortality And Morbidity ◽  
Protein Levels ◽  
Time Period ◽  
High Level

Sepsis in newborns with RDSy and asphyxia is essential; it is a life-threatening condition and still represents an important cause of mortality and morbidity. The aim of this study was to evaluate the predictive values of procalcitonin (PCT) as an early diagnostic and prognostic biochemical marker for sepsis in newborns with RDS and asphyxia. Material and methods: The study was designed as prospective and we examined 110 newborns with proven sepsis admitted in the Intensive  Care Unit at the University Clinic of Pediatrics – Skopje in the period between December 2018 and Јanuary 2021. Procalcitonin levels were measured by using the immunoassay system Vidas based on the ELFA principles. The newborns with proven sepsis were divided into two groups. The first group comprised 55 newborns with RDS and proven sepsis and the second group included 55 newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ​​of PCT in the analyzed time period in first group of newborns with RDS and proven sepsis, p<0.001. The highest average values (40.37±53.79) ​​were measured on admission with a high level of peak compared to the second group of newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ​​of PCT in the analyzed time period in the first group of newborns with RDS and proven sepsis with mechanical ventilation (MV) and bubble continuous positive airway pressure (BCPAP) compared to the second group of newborns with asphyxia  and proven sepsis,  p<0.001. PCT is a promising sepsis marker in newborns with RDSy, capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection at the time of ICU admission.  

scholarly journals Myxedema Coma in a Hypothermic, Obtunded Patient with Post-renal Acute Kidney Injury and Bacteremia in the Intensive Care Unit

2019 ◽  
Vol 14 (2) ◽  
pp. 38-41
Author(s):  
Hernan Dario Franco Lopez ◽  
Sameer Sharif ◽  
John Centofanti
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Obstructive Uropathy ◽  
Clinical Signs ◽  
Kidney Injury ◽  
Signs And Symptoms ◽  
Initial Diagnosis ◽  
Hypothyroid Patient ◽  
Profound Hypothermia ◽  
Myxedema Coma

We present a case of a hypothermic, unconscious patient transferred to our Intensive Care Unit with sepsis requiring mechanical ventilation. The absence of any known past medical history as well as concurrent obstructive uropathy and bacteremia made initial diagnosis challenging. He was eventually found to be in myxedema coma in light of evolving signs and laboratory investigations. This case emphasizes the need to consider myxedema coma in the differential diagnosis of profound hypothermia, especially when other clinical signs and symptoms may obscure its initial diagnosis, and lead clinicians to focus on the triggering event in isolation rather than concurrently managing hypothyroidism. This case highlights a challenging presentation of an uncommon, but life-threatening condition. We discuss the signs and symptoms present in the hypothyroid patient with myxedema coma; emphasize the pathophysiology of myxedema coma as well as the evidence-based acute management of this condition.

scholarly journals Incidence of Hospital-Acquired Bacterial Pneumonia and Its Resistance Profiles in Patients Admitted to Intensive Care Unit

2016 ◽  
Vol 9 (3) ◽  
pp. 73 ◽  
Author(s):  
Vahid Boostani ◽  
Farzaneh Dehghan ◽  
Afsaneh Karmostaji ◽  
Nader Zolghadri ◽  
Afsaneh Shafii
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Bacterial Pneumonia ◽  
Clinical Signs ◽  
Resistance Rate ◽  
Gram Negative Bacteria ◽  
Cross Sectional ◽  
Gram Negative ◽  
Hospital Acquired

<p>Hospital-acquired bacterial pneumonia (HABP) is one of the most important causes of morbidity, mortality and economic problems especially for patients admitted in the intensive care unit (ICU) ward. The aim of this study was to determine the incidence of nosocomial pneumonia in ICU, identify the causative bacteria and their resistance profiles. This cross sectional study was performed on 214 patients who were admitted in the ICU ward of a general hospital requiring mechanical ventilation for at least 48 h. Identification of HABP was based on the clinical signs manifested 48 h or more after admission, new chest X-ray infiltrates and microbiologic examination of endo tracheal secretion. Data were analyzed using SPSS 21 to perform the descriptive statistics. The isolated gram negative bacteria were <em>Klebsiella pneumoniae</em> (50%), <em>Staphylococcus aureus</em> (18.7%), <em>Acinetobacter baumannii</em> (12.5%), <em>Escherichia coli</em> (12.5%) and <em>Pseudomonas aeroginosa</em> (6.3%). The maximum antimicrobial resistance of gram negative bacteria was to Cefazolin (100%) and Ampicillin (84.6%), while antimicrobial resistance to Clindamycin, Azithromycin, Amoxycillin+clavulanate, Trimethoprim+sulfamethoxazole and Ciprofloxacin was 33.3%. No resistance was seen towards carbapenems.The most frequent gram negative isolated bacterium was <em>K. pneumoniae, </em>and maximum antimicrobial resistance rate was observed for Cefazolin and Ampicillin, which is due to betalactamase production.</p>

scholarly journals Increase of Non-Albicans Candida Species and Their Antifungal Susceptibility in Intensive Care Unit Patients (Mexico)

2021 ◽  
Author(s):  
Rosa Paulina Calvillo-Medina ◽  
Rocio Alejandrina Mejía-Romero ◽  
Magda Martínez-Neria ◽  
Juan José Olalde-Elias ◽  
Fernando Domínguez-Márquez
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antifungal Susceptibility ◽  
Clinical Signs ◽  
Empirical Therapy ◽  
Yeast Infection ◽  
Yeast Cultures ◽  
Bronchial Aspirate ◽  
Automated Instrument ◽  
Common Infection

Abstract In Mexico little is known about candidemia by non-albicans Candida species and regarding their antifungal susceptibility. Besides without antifungal tests, fluconazole is one of the most used in empirical therapy. In the present study, we included patients from intensive care unit of one hospital in Mexico (2019–2020) with compatible yeast infection clinical signs, symptoms. Based on cultivable isolates, yeasts were identified by automated instrument and by molecular method (PCR), and their susceptibilities to six antifungals were characterized at different concentrations. From 105 patients, yeast cultures were recovered and identified mainly non-albicans Candida species (57.2%); and the most prevalent was C. glabrata (41.9%). Followed by C. albicans, C. krusei, C. parapsilosis, C. tropicalis and Cryptococcus neoformans. The most common infection site was urine (56%), followed by the bronchial aspirate (30%). Mostly the isolated fungi were susceptible to 5-flucytosine (98%) and to amphotericin B. Mainly C. glabrata followed by C. krusei and C. tropicalis were resistant to different concentrations of itraconazole, miconazole, and fluconazole. The present investigation contributes to the knowledge of non-albicans Candida species infections in patients and, opens the possibility for a better understanding and management in antifungal empirical therapy.in Mexico.

Clinical Predictability of Intraventricular Hemorrhage in Preterm Infants

PEDIATRICS ◽  
1980 ◽  
Vol 65 (1) ◽  
pp. 30-34
Author(s):  
Anthony Lazzara ◽  
Peter Ahmann ◽  
Francine Dykes ◽  
Alfred W. Brann ◽  
James Schwartz
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Preterm Infants ◽  
Blood Cells ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Clinical Signs ◽  
Packed Red Blood Cells

Ninety-eight infants of less than 35 weeks' gestation, consecutively admitted to a regional neonatal intensive care unit, were followed prior to computerized tomography (CT) scan for clinical signs of subependymal and/or intraventricular hemorrhage. The presence or absence of intracerebral hemorrhage was confirmed by CT scan in all patients, and the severity of hemorrhage was quantitated as mild, moderate, or marked. Thirty-seven out of 98 infants (38%) demonstrated intracerebral hemorrhage on CT scan; 20 of 37 (54%) were predicted clinically. Clinical predictability was related to severity of hemorrhage as quantitated by CT scan. Clinical signs that were found helpful in predicting subependymal and/ or intraventricular hemorrhage were fall in hematocrit, failure of rise in hematocrit with transfusion of packed red blood cells, tight fontanel, decrease in spontaneous activity, decreased tone, abnormal eye signs, and seizures.

Sensory room in a psychiatric intensive care unit

2020 ◽  
Vol 16 (1) ◽  
pp. 23-28
Author(s):  
Rebecca Davies ◽  
Kenneth Murphy ◽  
Faisil Sethi
Keyword(s):  
Mental Health ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Experience ◽  
Clinical Setting ◽  
Grey Literature ◽  
Intensive Care Unit Setting ◽  
Restrictive Practice ◽  
Pubmed Database ◽  
Mental Health Settings

Background: The use of sensory-based treatment developed in paediatric and neurodevelopment care is a relatively new practice in psychiatric intensive care and acute mental health settings. This report briefly reviews the literature on the use of sensory rooms in psychiatric intensive care units and acute mental health settings, and outlines the development of a sensory room in a female psychiatric intensive care unit.<br/> Method: We provide an account of the process of establishing a sensory room in a psychiatric intensive care unit setting, including considerations, protocol, training and feedback. The literature on sensory room use in psychiatric intensive care and acute mental health settings was reviewed using the PubMed database and Google Scholar for 'grey' literature.<br/> Results: Widespread positive patient and staff perspectives on sensory room use in psychiatric settings were identified in the literature. Some studies have identified links between sensory-based care and reduced rates of restrictive practice. Feedback from patients using the sensory room established in the report revealed themes of patients enjoying and valuing the practice, and highlighted the need for patient-centred choice in its provision.<br/> Conclusions: This report outlines the development of a sensory room in a female psychiatric intensive care unit and briefly reviews the literature on such, considering its efficacy in both patient experience and possible developments in reducing more restrictive practices in care in this clinical setting. It provides a basis for further evaluation and research on sensory room interventions and their effectiveness in improving clinical outcomes.

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