Posaconazole as part of the antifungal armamentarium in the intensive care unit - case reports from a surgical ICU

Mycoses ◽  
2010 ◽  
Vol 54 ◽  
pp. 45-48 ◽  
Author(s):  
Dominic Störzinger ◽  
Christoph Lichtenstern ◽  
Markus A. Weigand ◽  
Torsten Hoppe-Tichy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Reports ◽  
Surgical Icu

Appropriate Antibiotic Selection and Use for Intensive Care Unit Patients, Part I: Rationale for Antibiotic Choices

2018 ◽  
Author(s):  
Richard M Pino ◽  
Molly Paras ◽  
Erica S Shenoy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Vascular Supply ◽  
Surgical Patient ◽  
Risk Of Infection ◽  
Antibiotic Selection ◽  
Key Words Antibiotics ◽  
Surgical Icu ◽  
Selection Of

The aim of this review is to help clinicians optimize treatment of infections and reduce adverse events. With that goal in mind, we discuss the basis for the selection of antibiotics for the surgical patient in the intensive care unit (ICU), the mechanism of antibiotic action, and resistance of pathogens to antibiotic therapy—factors that may affect antibiotic levels, the rationales for dosing, and the role of antimicrobial stewardship programs. The evaluation and management of infections in critically ill patients are uniquely different from those of the general patient population. Age, medical comorbidities, alterations in anatomy, changes in vascular supply, insertion of vascular conduits, and orthopedic hardware are some factors that increase the risk of infection and influence antibiotic choice in the surgical ICU patient.  Key words: antibiotics, antibiotic resistance, antibiotic stewardship, intensive care unit

scholarly journals A pilot study assessing the spiritual, emotional, physical/environmental, and physiological needs of mechanically ventilated surgical intensive care unit patients via eye tracking devices, head nodding, and communication boards

2018 ◽  
Vol 3 (1) ◽  
pp. e000180 ◽  
Author(s):  
Erin I Duffy ◽  
Jonah Garry ◽  
Lillian Talbot ◽  
David Pasternak ◽  
Ashley Flinn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Eye Tracking ◽  
Tertiary Care ◽  
Basic Needs ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Head Nodding ◽  
Surgical Icu

BackgroundMechanically ventilated patients in the intensive care unit (ICU) are unable to communicate verbally. We sought to evaluate their needs via a communication board (CB) and a novel eye tracking device (ETD) that verbalizes selections made by gazing.MethodsThis was a pilot prospective study conducted in a tertiary care surgical ICU. Continuously mechanically ventilated adult surgical ICU patients with a Richmond Agitation-Sedation Scale score of −1 to +1, without cognitive impairment, were eligible. We asked patients four yes-or-no questions to assess basic needs regarding presence of pain, need for endotracheal suction, satisfactory room temperature, and position comfort. Patients were then asked if there was anything else that they wanted to communicate. All responses were confirmed by head nodding.ResultsThe median accuracy of the CB (100% (IQR 100%–100%)) for basic needs communication (yes/no questions) was comparable with that of the ETD (100% (IQR 68.8%–100%); p=0.14) in the 12 enrolled patients. Notably, 83% of patients desired to communicate additional information, ranging from spiritual (eg, desire for prayer/chaplain), emotional (eg, frustration, desire for comfort), physical/environmental (eg, television), to physiological (eg, thirst/hunger) needs.DiscussionThe majority of patients desired to communicate something other than basic needs. Unless specifically assessed via an assistive communication device (eg, CB or ETD), some of these other needs would have been difficult to discern.Level of evidenceIV therapeutic care/management.

scholarly journals Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Keith Killu ◽  
Victor Coba ◽  
Michael Mendez ◽  
Subhash Reddy ◽  
Tanja Adrzejewski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Care ◽  
Patient Management ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Fellowship Program ◽  
Icu Patients ◽  
Surgical Icu ◽  
New Diagnosis

Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care.Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year.Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720). Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435).Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied.

scholarly journals Chewing gum prophylaxis for postoperative nausea and vomiting in the intensive care unit: a pilot randomised controlled trial

2020 ◽  
Vol 22 (4) ◽  
pp. 321-326
Author(s):  
Hussam Abdelkarim ◽  
◽  
Natasha Ciampoli ◽  
Lara Zwakman-Hessels ◽  
Jai N Darvall ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Randomised Controlled Trial ◽  
Postoperative Nausea ◽  
Controlled Trial ◽  
Postoperative Nausea And Vomiting ◽  
Chewing Gum ◽  
Pilot Randomised Controlled Trial ◽  
Surgical Icu ◽  
Randomised Controlled

Objective: To test the effectiveness of chewing gum in the prophylaxis of postoperative nausea and vomiting (PONV) in patients admitted to the intensive care unit (ICU) after surgery. Design: Prospective, open label, pilot randomised controlled trial. Setting: Two metropolitan ICUs. Participants: Ninety postoperative adult patients admitted to the ICU. Intervention: Patients administered chewing gum, who chewed for at least 15 minutes every 4 hours, were compared with a control group, who were administered a 20 mL sip of water orally every 4 hours. Main outcome measures: The primary outcome was the number of patient-reported episodes of nausea in the first 24 hours after the operation. Secondary outcomes included vomiting or dry retching episodes, and duration and severity of nausea. Results: Forty-six patients were randomly allocated to chewing gum and 44 patients to water. There was no difference between groups in the number of patients with nausea (10 [22%] chewing gum v 12 [27%] control patients; P = 0.72), nausea episodes (22 episodes; [median, 0; IQR, 0–0] v 21 episodes [median, 0; IQR, 0–1] per patient in each group respectively), vomiting/retching (2 [4%] chewing gum v 6 [14%] control patients; P = 0.24), or duration/severity of nausea. Conclusion: Regular postoperative administration of chewing gum in a surgical ICU patient cohort did not reduce nausea, vomiting or retching. The prevalence of PONV is less than previously reported. Our findings can inform future studies of PONV prophylaxis in post-surgical ICU patients. Trial registration: Australian New Zealand Clinical Trial Registry No. ACTRN12617001185358.

Essay: Celebrating New Life in a Neuro-Surgical ICU

2014 ◽  
Vol 18 (3) ◽  
pp. 65-66
Author(s):  
Marlienne Goldin,
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Real Time ◽  
Nursing Staff ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Grand Mal ◽  
Surgical Icu ◽  
New Mother ◽  
First Time

Caritas nurses cultivate the soul and spirit of their patients, as well as attend to their emotional and physical needs. This exemplar of caritas nursing shows how the nursing staff in a neuro-surgical intensive care unit (ICU), where a new mother had been admitted after having grand mal seizures during delivery, used technology to bring mother and baby together. Using iPhones and Facetime, the ICU nurses arranged for the mother to see her baby boy in the newborn nursery for the very first time, in real time. This caring moment exemplifies many of Watson’s caritas processes. Participating in these caring moments is the greatest reward of nursing.

Risk Factors for Infection and Molecular Typing in Patients in the Intensive Care Unit Colonized with NosocomialEnterobacter Aerogenes

2002 ◽  
Vol 23 (8) ◽  
pp. 452-456 ◽  
Author(s):  
Michael Piagnerelli ◽  
Eric Carlier ◽  
Ariane Deplano ◽  
Philippe Lejeune ◽  
Danielle Govaerts
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care ◽  
Enterobacter Aerogenes ◽  
Care Hospital ◽  
Younger Age ◽  
Infection Risk Factors ◽  
Surgical Icu ◽  
Prolonged Hospital

Objectives:To determine the frequency of colonization byEnterobacter aerogenesin patients in the intensive care unit (ICU) for more than 48 hours and to evaluate the risk factors for infection in patients colonized by this bacteria.Design:An 8-month prospective study.Setting:A 12-bed medical–surgical ICU in a 450-bed, university-affiliated, tertiary-care hospital in Belgium.Method:Pulsed-field gel electrophoresis was used to determine the genotypes ofE. aerogenesisolates.Results:We observed two major clones ofE. aerogenesin the ICU. Interestingly, 87.5% of infected patients had the same genomic profile for colonization and infection. Risk factors for infection in this particular population included younger age, prolonged hospital stay, mechanical ventilation, and bronchoscopy.Conclusions:Colonization is a major prerequisite for infection. The identification of risk factors for infection in colonized patients can optimize the quality of treatment in the ICU.

Blood Glucose Variability is Associated with Mortality in the Surgical Intensive Care Unit

2008 ◽  
Vol 74 (8) ◽  
pp. 679-685 ◽  
Author(s):  
Lesly A. Dossett ◽  
Hanqing Cao ◽  
Nathan T. Mowery ◽  
Marcus J. Dortch ◽  
John M. Morris ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Insulin Dose ◽  
Standard Of Care ◽  
Glucose Variability ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Blood Glucose Variability ◽  
Surgical Icu

Intensive insulin therapy has widely and rapidly been adopted as the standard of care for the treatment of hyperglycemia in the intensive care unit (ICU). Variability in blood glucose is increasingly recognized as an important factor in outcomes in the chronic diabetic in addition to hemoglobin A1C. We tested the hypothesis that measures of blood glucose variability would be associated with mortality in the surgical ICU. A retrospective analysis of a cohort of ventilated, critically ill surgical and trauma ICU patients placed on an automated insulin protocol was performed. Blood glucose (BG) variability was measured by comparing standard deviation, percentile values, successive changes in blood glucose, and by calculating the triangular index for various glucose-related indices. Eight hundred and fifty-eight patients had 46,474 blood glucose and insulin dose data points. One hundred and twenty-one patients died for an overall mortality rate of 14 per cent. Several measures of blood glucose variability (maximum successive change in BG and the triangular index) were different between the groups despite similar mean BG between survivors (117 mg/dL) and nonsurvivors (118 mg/dL). Increased blood glucose variability is associated with mortality in the surgical ICU. Further studies should focus on the demographic, clinical, and genetic factors responsible for this observation and identify strategies to minimize BG variability.

Surgical Intensive Care Unit Mobility is Increased after Institution of a Computerized Mobility Order Set and Intensive Care Unit Mobility Protocol: A Prospective Cohort Analysis

2010 ◽  
Vol 76 (8) ◽  
pp. 818-822 ◽  
Author(s):  
Amy N. Hildreth ◽  
Toby Enniss ◽  
Robert S. Martin ◽  
Preston R. Miller ◽  
Donna Mitten-Long ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Cohort Analysis ◽  
Surgical Intensive Care Unit ◽  
Inclusion Criteria ◽  
Surgical Intensive Care ◽  
Surgical Icu ◽  
Baseline Characteristics ◽  
Order Set

In some populations, intensive care unit (ICU) mobility has been shown to be safe and beneficial. We gathered data on 50 nonintubated surgical patients in a 10-bed surgical ICU (SICU) who met physiologic inclusion criteria beginning in May 2008 (A group). In January 2009, we began mandatory entry of computerized mobility orders as part of a standardized ICU order set. We also created a mobility protocol for nurses in this ICU. We then collected data on 50 patients in this postintervention cohort (B group). Both groups had similar baseline characteristics. A group patients had some form of mobility orders entered in 29 patients (58%) versus 47 patients (82%) in the B group, P < 0.05. In the A group, 11 patients (22%) were mobilized; in the B group, 40 patients (80%) were mobilized, P < 0.05. In our SICU patient population, mandatory entry of computerized mobility orders as part of a standard SICU order set and establishment of an ICU mobility nursing protocol was associated with an increase in number of mobility orders entered as well as an increase in SICU patient activity. Further studies should focus on measurement of the effect of mobility interventions on patient outcomes.

scholarly journals Ramelteon for Decreasing Delirium in Surgical Intensive Care Unit Patients

2020 ◽  
Vol 11 ◽  
pp. 117955732095122
Author(s):  
Chelsea N Lopez ◽  
Amaris Fuentes ◽  
Atiya Dhala ◽  
Jonathan Balk
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Median Number ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Primary Objective ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Patients ◽  
Surgical Icu

In intensive care unit (ICU) patients, delirium contributes to prolonged hospitalization, long-term cognitive impairment and increased mortality. Sleep disturbance, a risk factor for delirium, has been attributed to impaired melatonin secretion in critically ill patients. Ramelteon, a synthetic melatonin receptor agonist, is indicated for insomnia; there is limited, but growing evidence, to support its use for the prevention of delirium. The primary objective of this study is to describe the use of ramelteon and the incidence of delirium, assessed by Confusion Assessment Method for the ICU (CAM-ICU) scores, in adult surgical ICU patients from May 22, 2016 to June 30, 2018. The primary endpoint is the number of delirium free days in the week prior to and post first ramelteon administration. A total of 231 patients were included in the study with 201 (87%) positive for delirium at least once during the study timeframe. The median number of CAM-ICU negative days in the week pre-ramelteon administration was 4 days (IQR 2-7 days) compared to 6 days (IQR 3-7 days) in the week post-first ramelteon administration ( P < .05). The time to CAM-ICU positive increased slightly to 3 days (IQR 1-7 days) following ramelteon initiation compared to 2 days (IQR 1-5 days) from initial ICU admission. Additionally, the median number of antipsychotic doses per patient decreased from 4 doses (IQR 1.25-14 doses) prior to ramelteon to 2 doses (IQR 1-4 doses) after ramelteon. Ramelteon administration was associated with a greater number of CAM-ICU negative days in surgical ICU patients. These findings describe a potential role for ramelteon in mitigating delirium in this patient population.

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