Pulmonary Complications From Nasoenteral Feeding Tube Insertion in an Intensive Care Unit: Incidence and Prevention M.R. HARRIS, J.S. HUSEBY Departments of Nursing and Medicine, Providence Medical Center, and the University of Washington, Seattle, Washington

Object External ventricular drain (EVD) placement is one of the most common neurosurgical procedures performed. Rates and significance of hemorrhage associated with this procedure have not been well quantified. Methods All adults who underwent EVD placement at the University of Pittsburgh Medical Center between July 2002 and June 2003 were evaluated for catheter-associated hemorrhage. Patients without postprocedural imaging were excluded. Results Seventy-seven (41%) of 188 EVDs were associated with imaging evidence of hemorrhage after either placement or removal. Most of these were insignificant, punctate intraparenchymal, or trace subarachnoid hemorrhages (51.9%). Thirty-seven (19.7%) were associated with larger hemorrhages, which were divided into 3 groups according to volume of hemorrhage: 16 patients (8.5%) had < 15 ml of hemorrhage, 20 (10.6%) had hemorrhages of > 15 ml or associated intraventricular hemorrhage, and in 1 case there was a subdural hematoma that required surgical evacuation. No hemorrhages larger than punctate or trace were seen after EVD removal. Hemorrhage was associated with 44.3% of EVDs placed in an intensive care unit compared with 34.8% in EVDs placed in the operating room (p > 0.10). Conclusions External ventricular drain placement has a significant risk of associated hemorrhage. However, the hemorrhages are rarely large and almost never require surgical intervention. There is a favorable trend, but no significant risk reduction when EVDs are placed in the operating room rather than the intensive care unit.

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FOALS ARE GETTING HELP

PEDIATRICS ◽

10.1542/peds.84.4.a96 ◽

1989 ◽

Vol 84 (4) ◽

pp. A96-A96

Author(s):

J. F. L.

Keyword(s):

Intensive Care Unit ◽

Veterinary Medicine ◽

Intensive Care ◽

Birth Defects ◽

Human Medicine ◽

University Of Pennsylvania ◽

Twin Brother ◽

Pennsylvania Hospital ◽

The University

KENNETT SQUARE, Pa.—Nearly as rare as the colt that grows up to be a racing champion is the birth of twin foals. Yet a tiny and brave filly and her weaker twin brother grow stronger every day here in an intensive care unit for newborn horses. Established in 1983 and directed . . . by Dr. Wendy E. Vaala, a . . . veterinarian, the University of Pennsylvania's intensive care unit for foals was built. . . . It is one of only seven such units in the country, and they have led to the development of a new specialty in veterinary medicine—equine neonatology. Recipes for formula fed to foals were borrowed from those used at the University of Pennsylvania Hospital in Philadelphia. The intensive care unit uses ultrasound equipment, heart monitors and other devices commonly used in human neonatal medicine. Treatments for infections, poisoning, ulcers, birth defects, even difficult births were adopted from human medicine. . . . But there are no incubators. . . .The foals are too active.

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Middle meatal vs antral lavage cultures in intensive care unit patients

Otolaryngology ◽

10.1067/mhn.2002.123444 ◽

2002 ◽

Vol 126 (4) ◽

pp. 377-381 ◽

Cited By ~ 11

Author(s):

Stilianos E. Kountakis ◽

Ioannis G. Skoulas

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prospective Study ◽

Medical Center ◽

Icu Patients

OBJECTIVE: The study goal was to compare endoscopically guided middle meatal cultures with cultures of antral lavage aspirate in intensive care unit (ICU) patients with sinusitis. METHODS: Prospective study of febrile ICU patients seen for sinusitis at a tertiary medical center. RESULTS: Of 31 antral lavages performed in 18 patients, 19 lavages yielded purulent or mucopurulent aspirate. Endoscopically guided middle meatal cultures yielded the same pathogen, as did cultures of the lavage aspirate in 4 (21%) of these 19 cases. The antral lavage was negative (absence of purulent/mucopurulent aspirate) in 12 cases, and of those, 5 (42%) of the 12 middle meatal cultures showed no growth (sensitivity = 21%, specificity = 58%, χ2-1.52, P = 0.218). CONCLUSION: Endoscopically guided middle meatal cultures did not correlate well with cultures from the antral lavage aspirate in febrile ICU patients evaluated for sinusitis.

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Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

Children ◽

10.3390/children8111035 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1035

Author(s):

Rachel K. Marlow ◽

Sydney Brouillette ◽

Vannessa Williams ◽

Ariann Lenihan ◽

Nichole Nemec ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Medical Center ◽

Invasive Mechanical Ventilation ◽

Severity Of Illness ◽

Pediatric Intensive Care ◽

Respiratory Support ◽

Non Invasive ◽

Lengths Of Stay

The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.

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Prognostic Factors for Acute Heart Failure (AHF) in the Cardiology Intensive Care Unit (ICU) of the University Hospital Point G (UH Pt G)

World Journal of Cardiovascular Diseases ◽

10.4236/wjcd.2019.91005 ◽

2019 ◽

Vol 09 (01) ◽

pp. 42-50

Author(s):

Camara Youssouf ◽

Ba Hamidou Oumar ◽

Sangare Ibrahima ◽

Toure Karamba ◽

Coulibaly Souleymane ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care Unit ◽

Intensive Care ◽

Prognostic Factors ◽

Acute Heart Failure ◽

University Hospital ◽

Point G ◽

The University

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Vancomycin-induced nephrotoxicity in non-intensive care unit pediatric patients

Scientific Reports ◽

10.1038/s41598-021-00214-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shinhyeung Kwak ◽

Jeong Yeon Kim ◽

Heeyeon Cho

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Patients ◽

Trough Level ◽

Medical Center ◽

Kidney Injury ◽

Maximum Serum ◽

Serum Trough ◽

Youden’S Index

AbstractPrevious data suggested several risk factors for vancomycin-induced nephrotoxicity (VIN), including higher daily dose, long-term use, underlying renal disease, intensive care unit (ICU) admission, and concomitant use of nephrotoxic medications. We conducted this study to investigate the prevalence and risk factors of VIN and to estimate the cut-off serum trough level for predicting acute kidney injury (AKI) in non-ICU pediatric patients. This was a retrospective, observational, single-center study at Samsung Medical Center tertiary hospital, located in Seoul, South Korea. We reviewed the medical records of non-ICU pediatric patients, under 19 years of age with no evidence of previous renal insufficiency, who received vancomycin for more than 48 h between January 2009 and December 2018. The clinical characteristics were compared between patients with AKI and those without to identify the risk factors associated with VIN, and the cut-off value of serum trough level to predict the occurrence of VIN was calculated by the Youden’s index. Among 476 cases, 22 patients (4.62%) developed AKI. The Youden’s index indicated that a maximum serum trough level of vancomycin above 24.35 μg/mL predicted VIN. In multivariate analysis, longer hospital stay, concomitant use of piperacillin-tazobactam and serum trough level of vancomycin above 24.35 μg/mL were associated independently with VIN. Our findings suggest that concomitant use of nephrotoxic medication and higher serum trough level of vancomycin might be associated with the risk of VIN. This study suggests that measuring serum trough level of vancomycin can help clinicians prevent VIN in pediatric patients.

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