scholarly journals Temporal artery temperature measurements versus bladder temperature in critically ill patients, a prospective observational study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241846
Author(s):  
Eline G. M. Cox ◽  
Willem Dieperink ◽  
Renske Wiersema ◽  
Frank Doesburg ◽  
Ingeborg C. van der Meulen ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Critically Ill ◽  
Subgroup Analysis ◽  
Critically Ill Patients ◽  
A Priori ◽  
Reference Method ◽  
Temporal Artery ◽  
Test Method ◽  
Temperature Measurements ◽  
Bladder Temperature

Purpose Accurate measurement of body temperature is important for the timely detection of fever or hypothermia in critically ill patients. In this prospective study, we evaluated whether the agreement between temperature measurements obtained with TAT (test method) and bladder catheter-derived temperature measurements (BT; reference method) is sufficient for clinical practice in critically ill patients. Methods Patients acutely admitted to the Intensive Care Unit were included. After BT was recorded TAT measurements were performed by two independent researchers (TAT1; TAT2). The agreement between TAT and BT was assessed using Bland-Altman plots. Clinical acceptable limits of agreement (LOA) were defined a priori (<0.5°C). Subgroup analysis was performed in patients receiving norepinephrine. Results In total, 90 critically ill patients (64 males; mean age 62 years) were included. The observed mean difference (TAT-BT; ±SD, 95% LOA) between TAT and BT was 0.12°C (-1.08°C to +1.32°C) for TAT1 and 0.14°C (-1.05°C to +1.33°C) for TAT2. 36% (TAT1) and 42% (TAT2) of all paired measurements failed to meet the acceptable LOA of 0.5°C. Subgroup analysis showed that when patients were receiving intravenous norepinephrine, the measurements of the test method deviated more from the reference method (p = NS). Conclusion The TAT is not sufficient for clinical practice in critically ill adults.

scholarly journals Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

Nutrients ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 82
Author(s):  
Magdalena Hoffmann ◽  
Christine Maria Schwarz ◽  
Stefan Fürst ◽  
Christina Starchl ◽  
Elisabeth Lobmeyr ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Clinical Practice ◽  
Literature Review ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rapid Review ◽  
Narrative Synthesis ◽  
Safety Issues

Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice.

Music therapy in critical care: indications and guidelines for intervention

1999 ◽  
Vol 19 (3) ◽  
pp. 35-41 ◽  
Author(s):  
L Chlan ◽  
MF Tracy
Keyword(s):  
Critical Care ◽  
Clinical Practice ◽  
Music Therapy ◽  
Stress Management ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Anxiety Reduction ◽  
Music Listening ◽  
Sense Of Control ◽  
Music Selection

Music therapy is an effective intervention for critically ill patients for such purposes as anxiety reduction and stress management. The therapy is readily accepted by patients and is an intervention patients thoroughly enjoy. The MAIT is one resource that nurses caring for critically ill patients can use to implement music therapy in clinical practice. Patients can be given the opportunity to select a musical tape they prefer and to negotiate with the nurse for uninterrupted music-listening periods. Allowing patients control over music selection and providing uninterrupted time for music listening gives the patients an enhanced sense of control in an environment that often controls them.

Serum Albumin Levels: Who Needs Them?

2020 ◽  
pp. 106002802095934 ◽  
Author(s):  
Brian L. Erstad
Keyword(s):  
Clinical Practice ◽  
Serum Albumin ◽  
Critically Ill ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
Current Clinical Practice ◽  
Albumin Administration ◽  
Nutritional Monitoring

Objectives The purpose of this critical narrative review is to discuss common indications for ordering serum albumin levels in adult critically ill patients, evaluate the literature supporting these indications, and provide recommendations for the appropriate ordering of serum albumin levels. Data Sources PubMed (1966 to August 2020), Cochrane Library, and current clinical practice guidelines were used, and bibliographies of retrieved articles were searched for additional articles. Study Selection and Data Extraction Current clinical practice guidelines were the preferred source of recommendations regarding serum albumin levels for guiding albumin administration and for nutritional monitoring. When current comprehensive reviews were available, they served as a baseline information with supplementation by subsequent studies. Data Synthesis Serum albumin is a general marker of severity of illness, and hypoalbuminemia is associated with poor patient outcome, but albumin is an acute phase protein, so levels vacillate in critically ill patients in conjunction with illness fluctuations. The most common reasons for ordering serum albumin levels in intensive care unit (ICU) settings are to guide albumin administration, to estimate free phenytoin or calcium levels, for nutritional monitoring, and for severity-of-illness assessment. Relevance to Patient Care and Clinical Practice Because hypoalbuminemia is common in the ICU setting, inappropriate ordering of serum albumin levels may lead to unnecessary albumin administration or excessive macronutrient administration in nutritional regimens, leading to possible adverse effects and added costs. Conclusions With the exception of the need to order serum albumin levels as a component of selected severity-of-illness scoring systems, there is little evidence or justification for routinely ordering levels in critically ill patients.

scholarly journals Serum anion gap is associated with all-cause mortality among critically ill patients with congestive heart failure

2020 ◽  
Author(s):  
yiyang tang ◽  
wenchao lin ◽  
lihuang zha ◽  
xiaofang zeng ◽  
zhenghui liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Critically Ill ◽  
Subgroup Analysis ◽  
Critically Ill Patients ◽  
Demographic Data ◽  
Cox Proportional Hazards ◽  
Anion Gap ◽  
High Morbidity ◽  
All Cause Mortality

Background: Congestive heart failure (CHF) is a complex clinical syndrome, with high morbidity and mortality. Serum anion gap (SAG) has been known to be associated with the severity of various cardiovascular diseases. However, the role of SAG indicators in CHF is unclear. Methods and results: A retrospective analysis of data from MIMIC-III v1.4 was conducted in critically ill patients with CHF. Clinical information of each patient, including demographic data, comorbidities, vital signs, scores, and laboratory indicators, were successfully obtained. Cox proportional hazards models were performed to determine the relationship between SAG and mortality in CHF patient, the consistency of which was further verified by subgroup analysis. Results: A total of 7426 subjects met the inclusion criteria. In multivariate analysis, after adjusting for age, gender, ethnicity, and other potential confounders, higher SAG was significantly related to an increase in 30-day and 90-day all-cause mortality of critically ill patients with CHF compared with lower SAG (tertile3 vs tertile1: adjusted HR, 95% CI: 1.74, 1.46-2.08; 1.53, 1.32-1.77). In subgroup analysis, the association between SAG and all-cause mortality present similarities in most strata. Conclusion: SAG at admission can be a promising predictor of all-cause mortality in critically ill patients with CHF.

scholarly journals Accuracy of zero-heat-flux thermometry and bladder temperature measurement in critically ill patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Anselm Bräuer ◽  
Albulena Fazliu ◽  
Thorsten Perl ◽  
Daniel Heise ◽  
Konrad Meissner ◽  
...  
Keyword(s):  
Heat Flux ◽  
Critically Ill ◽  
Core Temperature ◽  
Critically Ill Patients ◽  
Gold Standard ◽  
Prospective Observational Study ◽  
Standard Of Care ◽  
Limits Of Agreement ◽  
Blood Temperature ◽  
Bladder Temperature

AbstractCore temperature (TCore) monitoring is essential in intensive care medicine. Bladder temperature is the standard of care in many institutions, but not possible in all patients. We therefore compared core temperature measured with a zero-heat flux thermometer (TZHF) and with a bladder catheter (TBladder) against blood temperature (TBlood) as a gold standard in 50 critically ill patients in a prospective, observational study. Every 30 min TBlood, TBladder and TZHF were documented simultaneously. Bland–Altman statistics were used for interpretation. 7018 pairs of measurements for the comparison of TBlood with TZHF and 7265 pairs of measurements for the comparison of TBlood with TBladder could be used. TBladder represented TBlood more accurate than TZHF. In the Bland Altman analyses the bias was smaller (0.05 °C vs. − 0.12 °C) and limits of agreement were narrower (0.64 °C to − 0.54 °C vs. 0.51 °C to – 0.76 °C), but not in clinically meaningful amounts. In conclusion the results for zero-heat-flux and bladder temperatures were virtually identical within about a tenth of a degree, although TZHF tended to underestimate TBlood. Therefore, either is suitable for clinical use.German Clinical Trials Register, DRKS00015482, Registered on 20th September 2018, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00015482.

T1040 Stress Bleeding Prophylaxis in Critically Ill Patients: Survey of the Clinical Practice

2008 ◽  
Vol 134 (4) ◽  
pp. A-470
Author(s):  
Stefanie Zierhut ◽  
Sylvia Siebig ◽  
Tanja Bruennler ◽  
Falitsa Mandraka ◽  
Felix Rockmann ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bleeding Prophylaxis ◽  
Stress Bleeding

scholarly journals 2117. Fluconazole vs. Echinocandins as Initial Therapy for Candidemia Caused by Fluconazole-Susceptible Species in the Era of Rapid Diagnostic Testing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S716-S716
Author(s):  
Danya Roshdy ◽  
Tyler Ginn ◽  
Rupal K Jaffa ◽  
William E Anderson ◽  
Elizabeth Green ◽  
...  
Keyword(s):  
Blood Culture ◽  
Critically Ill ◽  
Positive Blood Culture ◽  
Subgroup Analysis ◽  
Critically Ill Patients ◽  
Diagnostic Testing ◽  
Initial Therapy ◽  
Clinical Failure ◽  
Rapid Diagnostic Testing ◽  
All Cause Mortality

Abstract Background Echinocandins (ECH) are recommended first-line for initial therapy (IT) of candidemia (CD) over fluconazole (FLU) due to their broad spectrum of activity. This recommendation was made prior to widespread implementation of rapid diagnostic testing (RDT), allowing prompt species identification and targeted therapy. The objective of this study was to compare clinical outcomes in patients with CD caused by FLU-susceptible species who received either FLU or ECH as IT. Methods This was a multicenter, retrospective cohort study of adults with CD caused by C. albicans, C. tropicalis, or C. parapsilosis. Patients who received FLU or ECH as IT for at least 48 hours from May 2012 to October 2018 were included. Patients who died within 48 hours of first positive blood culture were excluded. The primary endpoint was the rate of clinical failure (persistent CD for >72 hours, recurrent infection within 30 days, change in therapy, and all-cause mortality within 30 days). Secondary endpoints included 90-day all-cause mortality and time to culture clearance. A subgroup analysis in critically ill patients was conducted. Results Of the 371 patients evaluated, 128 met criteria for inclusion, 57 received FLU and 71 received ECH. Patients in the ECH group had a higher incidence of sepsis at the time of first positive blood culture (45.1% vs. 19.3%, P = 0.002). A line-associated source was more common in the ECH group (56.3%) vs. urinary source in the FLU group (21.1%). C. albicans was most common in both groups (63%). Clinical failure was similar in the FLU and ECH groups (38.6% vs. 35.2%, P = 0.69). 90-day mortality and time to culture clearance (1.6 vs. 1.5 days, P = 0.63) did not yield significant differences. In the subgroup analysis of critically ill patients, there was a trend suggesting higher rate of failure in patients who received FLU vs. an ECH (60.9% vs. 47.7%, P = 0.31), though underpowered to detect such a difference. Length of stay (LOS) was shorter in patients who received FLU (12 vs. 18 days, P = 0.018). Conclusion FLU as IT for FLU-susceptible CD may be a reasonable option in non-critically ill patients in the setting of RDT. This may lead to shorter LOS given the availability of an oral formulation. Additional prospective studies are needed to validate these conclusions. Disclosures All authors: No reported disclosures.

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