Impact of infusion therapy programs on homeostasis indicators in patients suffering from shockogenic trauma from the point of view of statistical reliability

From the point of view of statistical reliability, the influence of various infusion therapy programs on homeostasis indicators of patients suffering from shockogenic trauma is considered. It has been revealed that when entering the intensive care and intensive care department in patients suffering from severe traumatic shock, against the background of algorithms of anti-shock measures at the pre-emergency and hospital stages there are significant individual intervals of examined homeostasis parameters, which indicates expressed personalized disorders of indicators of reflecting function of organs and systems of patients. The variation in the canonical space of the investigated parameters in patients increased after 12 hours, after admission to the intensive care and resuscitation department. Anti-shock therapy contributed to the fact that the distribution of patients of all three groups in the canonical space after the first 24 hours was dynamically compacted, indicating a decrease in differences between patients of each group during the treatment process. Cluster analysis and multi-dimensional scaling revealed the multilateral dynamics of the relationship between independent variables in various infusion therapy programmes. When patients were admitted to the intensive care and intensive care unit, almost the same orientation of the features of connections between independent variables was noted, however, their polarity was recorded during the treatment process. This shows that the infusion therapy program in patients suffering from severe traumatic shock should be carried out taking into account the dynamics of individual disorders of the investigated homeostasis parameters. It has been statistically proven that different infusion therapy programs have very different effects on homeostasis rates. The use of sterofundin isotonic and 4% modified gelatin in this category of patients has been proven to be the most effective and safe volemic recovery scheme.

Download Full-text

Continued Enteral Feeding Is Beneficial in Hypoglycemic Infants Admitted to Intensive Care for Parenteral Dextrose Therapy

Global Pediatric Health ◽

10.1177/2333794x19857415 ◽

2019 ◽

Vol 6 ◽

pp. 2333794X1985741

Author(s):

Mahdi Alsaleem ◽

Lina Saadeh ◽

Vasantha H. S. Kumar ◽

Gregory E. Wilding ◽

Lorin Miller ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care ◽

Newborn Infants ◽

Glucose Infusion ◽

Infusion Therapy ◽

Care Providers ◽

Neonatal Hypoglycemia ◽

Lower Maximum ◽

Length Of Hospitalization

There is variability in practice among care providers on feeding infants admitted with neonatal hypoglycemia (NH) for parenteral dextrose. We compared clinical outcomes in infants who were fed (NH-Fed) and hypoglycemic infants who were kept nothing per os (NPO) (NH-NPO) at the time of initiation of intravenous (IV) dextrose. We performed a retrospective review of all newborn infants admitted to the neonatal intensive care unit with NH for IV dextrose. Infants were grouped as per the feeding approach at initiation of IV dextrose: NH-Fed or NH-NPO infants. We found that infants in the NH-Fed group had lower maximum glucose infusion rate, less duration of glucose infusion therapy compared with the NH-NPO group, and significantly less number of days of hospital stay compared with the NH-NPO group (5.87 ± 1.4 days vs 4.9 ± 1.4 days, P < .006). In conclusion, feeding infants with hypoglycemia who require IV dextrose offers tangible benefits of shorter duration of parenteral dextrose and shorter length of hospitalization.

Download Full-text

The good, the bad and the ugly: pandemic priority decisions and triage

Journal of Medical Ethics ◽

10.1136/medethics-2020-106489 ◽

2020 ◽

pp. medethics-2020-106489 ◽

Cited By ~ 4

Author(s):

Hans Flaatten ◽

Vernon Van Heerden ◽

Christian Jung ◽

Michael Beil ◽

Susannah Leaver ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Point Of View ◽

Just In Time ◽

Time Period ◽

Utilitarian Approach ◽

Bed Capacity ◽

Trained Staff ◽

Short Time

In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. However, there is a limit where the hospitals may run out of resources to provide critical care, which is heavily dependent on trained staff, just-in-time supply chains for clinical consumables and drugs and advanced equipment. In the first (good) phase, we can still do clinical prioritisation and decision-making as usual, based on the need for intensive care and prognostication: what are the odds for a good result with regard to survival and quality of life. In the next (bad phase), the resources are mostly available, but the system is stressed by many patients arriving over a short time period and auxiliary beds in different places in the hospital being used. We may have to abandon admittance of patients with doubtful prognosis. In the last (ugly) phase, usual medical triage and priority setting may not be sufficient to decrease inflow and there may not be enough intensive care unit beds available. In this phase different criteria must be applied using a utilitarian approach for triage. We argue that this is an important transition where society, and not physicians, must provide guidance to support triage that is no longer based on medical priorities alone.

Download Full-text

Tuberculosis in the Intensive Care Unit: A Retrospective Descriptive Cohort Study with Determination of a Predictive Fatality Score

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2012/361292 ◽

2012 ◽

Vol 23 (4) ◽

pp. 173-178 ◽

Cited By ~ 14

Author(s):

Sandrine Valade ◽

Laurent Raskine ◽

Mounir Aout ◽

Isabelle Malissin ◽

Pierre Brun ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Multivariate Analysis ◽

Intensive Care ◽

Pulmonary Tuberculosis ◽

Tuberculosis Patients ◽

Independent Variables ◽

Related Mortality

BACKGROUND: Despite effective treatments, tuberculosis-related mortality remains high among patients requiring admission to the intensive care unit (ICU).OBJECTIVE: To determine prognostic factors of death in tuberculosis patients admitted to the ICU, and to develop a simple predictive scoring system.METHODS: A 10-year, retrospective study of 53 patients admitted consecutively to the Hôpitaux de Paris, Hôpital Lariboisière (Paris, France) ICU with confirmed tuberculosis, was conducted. A multivariate analysis was performed to identify risk factors for death. A predictive fatality score was determined.RESULTS: Diagnoses included pulmonary tuberculosis (96%) and tuberculous encephalomeningitis (26%). Patients required mechanical ventilation (45%) and vasopressor infusion (28%) on admission. Twenty patients (38%) died, related to direct tuberculosis-induced organ failure (n=5), pulmonary bacterial coinfections (n=14) and pulmonary embolism (n=1). Using a multivariate analysis, three independent factors on ICU admission were predictive of fatality: miliary pulmonary tuberculosis (OR 9.04 [95% CI 1.25 to 65.30]), mechanical ventilation (OR 11.36 [95% CI 1.55 to 83.48]) and vasopressor requirement (OR 8.45 [95% CI 1.29 to 55.18]). A score generated by summing these three independent variables was effective at predicting fatality with an area under the ROC curve of 0.92 (95% CI 0.85 to 0.98).CONCLUSIONS: Fatalities remain high in patients admitted to the ICU with tuberculosis. Miliary pulmonary tuberculosis, mechanical ventilation and vasopressor requirement on admission were predictive of death.

Download Full-text

High Incidence of Non-Neutropenic Infections Induced by Rituximab Plus Chemotherapy and Associated with Hypogammaglobulinemia: A Frequently Unrecognized and Easily Treatable Complication.

Blood ◽

10.1182/blood.v106.11.2445.2445 ◽

2005 ◽

Vol 106 (11) ◽

pp. 2445-2445

Author(s):

Fernando Cabanillas ◽

Orestes Pavia ◽

Ezequiel Rivera

Keyword(s):

Otitis Media ◽

Single Agent ◽

Female Gender ◽

Acute Onset ◽

Infusion Therapy ◽

Factors Associated ◽

Independent Variables ◽

Kaplan Meier ◽

High Incidence ◽

Different Types

Abstract In the pivotal single agent Rituximab trial, hypogammaglobulinemia occurred in only 14% of cases and was not considered to be associated with any morbidity. Our experience with the combination of Rituximab plus chemotherapy (R-Chemo) seemed to differ from the single agent experience and suggested that this complication might occur commonly as a consequence of therapy, can lead to significant infectious morbidity and frequently is not recognized by clinicians. We thus analyzed our experience with R-Chemo in 97 patients (median age 58) to determine: 1- frequency and type of non-neutropenic infections (NNI). 2- frequency and type of hypogammaglobulinemia. 3- response to gammablobulin infusion therapy. 4- factors associated with development of NNI. To be considered as NNI, only those cases of bronchitis, sinusitis or pneumonia of acute onset and lasting over two weeks in spite of antibiotics or relapsing immediately after discontinuation of antibiotics, were counted. Others counted as NNI were infections requiring hospitalization in spite of normal neutrophils and Herpes Zoster (H.Z.). We observed a total of 40 episodes of NNI in 19 pts for a total of 19/97 (20%) pts who developed some type of NNI. A Kaplan-Meier cumulative estimate revealed that by 3 years, 43% of pts treated with R-Chemo were projected to have developed at least one NNI. Of the 19 pts with NNI, 15 had Ig levels studied and all 15 had hypogammaglobulinemia. The most frequently affected Ig were IgG (14/15) and IgM (13/14). Ig A was usually spared (only 6/14 cases affected). Types of NNI observed were 18 bronchitis, 16 sinusitis, 4 pneumonias, 3 otitis media, 2 FUOs and 3 H.Z. Some pts had combined episodes of different types of NNI (ex. sinusitis and bronchitis) and 7/19 required hospitalization. Ten pts. received gammaglobulin infusions and all 10 cases responded promptly. Gammaglobulin infusions were given sporadically and only when NNIs recurred; their effect was long lasting, frequently for as long as 6–12 months after administration. We examined sex, age (<60 vs ≥60 ), histology (indolent vs aggressive), type of R-Chemo (Fludara+R vs other Chemo+R) for their correlation with development of NNI. Indolent histology, female sex and Fludara+R significantly correlated with NNI at P<.05 but multivariate analysis first picked Fludara+R followed by female gender as the only 2 independent variables predictive of NNI. Figure 1 below illustrates the cumulative incidence of NNI according to type of R-Chemo regimen. Figure Figure Conclusions: 1-Clinicians should be aware of the exceedingly high incidence of NNI and hypogammaglobulinemia associated with R-Chemo, particularly with, but not limited to Fludara+R. 2- This can lead to significant morbidity including hospitalizations and is usually manifested as either bronchitis, sinusitis, pneumonia, otitis media, and non-neutropenic FUO, frequently of delayed onset. 3-Females who receive Fludara-R are particularly prone to develop NNI (incidence is 63% in females vs 10% males, p=.01). 4- Hypogammaglobulinemia leading to NNI is a frequent cause of hospitalization. 5-Treatment with gammaglobulin infusion is very effective and there is no need to repeat it monthly.

Download Full-text

Spirituality in self-care for intensive care nursing professionals

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692008000200007 ◽

2008 ◽

Vol 16 (2) ◽

pp. 212-217 ◽

Cited By ~ 10

Author(s):

Luciana Winterkorn Dezorzi ◽

Maria da Graça Oliveira Crossetti

Keyword(s):

Intensive Care ◽

Close Contact ◽

Self Care ◽

Point Of View ◽

University Hospital ◽

Higher Power ◽

Self Knowledge ◽

Nursing Professionals ◽

Intensive Care Nursing ◽

Care Nursing

This study aimed to understand how spirituality permeates the process of caring for oneself and for others in the intensive care scenario from nursing professionals' point of view. This study used the qualitative approach of Cabral's Creative-Sensitive Method to guide information production and analysis in nine art and experience workshops. Nine nursing caregivers from the Intensive Care Unit (ICU) of a university hospital participated in the study. This article presents one of the topics that emerged during this process: spirituality in self-care, which is evidenced in the daily practices that take place through prayers, close contact with nature, as well as in the sense of connection with a Higher Power that provides peace, welfare, and greater strength to ICU caregivers' life and work. Self-knowledge emerged as an essential practice in caring for oneself, in order to deliver better care to others.

Download Full-text

Robust Optimization of Alginate-Carbopol 940 Bead Formulations

The Scientific World JOURNAL ◽

10.1100/2012/605610 ◽

2012 ◽

Vol 2012 ◽

pp. 1-15 ◽

Cited By ~ 3

Author(s):

J. M. López-Cacho ◽

Pedro L. González-R ◽

B. Talero ◽

A. M. Rabasco ◽

M. L. González-Rodríguez

Keyword(s):

Robust Optimization ◽

Signal To Noise Ratio ◽

High Variability ◽

Point Of View ◽

Orthogonal Array Design ◽

Complex Activity ◽

Drug Release Profile ◽

Independent Variables ◽

Taguchi Orthogonal Array ◽

Carbopol 940

Formulation process is a very complex activity which sometimes implicates taking decisions about parameters or variables to obtain the best results in a high variability or uncertainty context. Therefore, robust optimization tools can be very useful for obtaining high quality formulations. This paper proposes the optimization of different responses through the robust Taguchi method. Each response was evaluated like a noise variable, allowing the application of Taguchi techniques to obtain a response under the point of view of the signal to noise ratio. AL18Taguchi orthogonal array design was employed to investigate the effect of eight independent variables involved in the formulation of alginate-Carbopol beads. Responses evaluated were related to drug release profile from beads (t50%and AUC), swelling performance, encapsulation efficiency, shape and size parameters. Confirmation tests to verify the prediction model were carried out and the obtained results were very similar to those predicted in every profile. Results reveal that the robust optimization is a very useful approach that allows greater precision and accuracy to the desired value.

Download Full-text

The first domestic devices for intraosseous infusion - is the great advance of military medicine in pre-hospital stage enhancement

Vestnik of Russian military medical Academy ◽

10.17816/brmma12299 ◽

2018 ◽

Vol 20 (4) ◽

pp. 106-112

Author(s):

I M Samokhvalov ◽

K P Golovko ◽

A V Denisov ◽

S Yu Telitsky ◽

N A Zhirnova ◽

...

Keyword(s):

Blood Volume ◽

Medical Devices ◽

Limited Liability ◽

Traumatic Shock ◽

Infusion Therapy ◽

Volume Resuscitation ◽

Limited Liability Company ◽

Circulating Blood Volume ◽

Medical Evacuation ◽

Intraosseous Infusion

Traumatic shock is considered to be the most common clinical form of a severe patient’s condition (63%). Timely and adequate blood volume resuscitation is one of the most important procedures in providing medical care to critically injured casualties and patients at the forward medical evacuation stage. The key to this problem, especially when the infusion therapy is needed at the pre-hospital stage, is the development of alternative (extravascular) techniques of plasma volume expander administration. The article presents the results of testing of the first domestic medical devices for intraosseous infusion in critically injured casualties and patients. At present, on commission of the Russian Ministry of Defense and with the scientific support of Kirov Military Medical Academy, domestic enterprises developed test samples of medical devices to provide intraosseous infusions: a «Disposable device for intraosseous infusion of solutions if there is no intravenous access, which was designed on the basis of a spring drive» - the index «VKI-P», developed by limited liability company «Novoplast-М» and a set for intraosseous infusion using an electric drive - the index « VKI-E», developed by limited liability company «Research engineering company «Spetsproekt». Assessment of performance of test samples of the medical devices for intraosseous infusions «VKI-P» and «VKI-E» was carried out using pathophysiologic model of traumatic shock in 14 experimental animals (pigs) by creating artificial blood loss of medium severity, 25% of circulating blood volume (in average 440 ml), followed by its resuscitation with intraosseous infusion of 0,9% solution of NaCl. As a result of the performed tests it was found that the device «VKI-P» and the set «VKI-E» provide for NaCl infusion in major vessels (with an intraosseous infusion), 750 ml of volume during 45-50 min, and can be used as an alternative access to provide infusion as a part of anti-shock therapy, which solves the problem of volume resuscitation when giving care to severely injured casualties and patients at the forward medical evacuation stages. These samples may be recommended for inclusion into the medical service list of complete supplies and the Medical Corps supply support, the Armed Forces of the Russian Federation.

Download Full-text

Clinical observations of live improvisational harp music in neonatal intensive care

Music and Medicine ◽

10.47513/mmd.v10i2.497 ◽

2018 ◽

Vol 10 (2) ◽

pp. 63

Author(s):

Roxanne McLeod ◽

Kaye Spence

Keyword(s):

Intensive Care ◽

Music Therapy ◽

Neonatal Intensive Care ◽

Neonatal Intensive Care Units ◽

Music Therapist ◽

Therapy Program ◽

Clinical Observations ◽

Live Music ◽

Experienced Nurse ◽

Therapy Sessions

The use of Music Therapy (MT) in Neonatal Intensive Care Units (NICU) has received growing attention through an increasing body of research. MT research in NICUs have shown benefits in the use of both recorded and live music, a recent study has indicated that live music produces more beneficial outcomes in some domains, and is often perceived as more beneficial by parents. As part of the developmental program in a NICU, music therapy by a Registered Music Therapist was implemented for long-stay infants and their families. The live music therapy sessions using a Reverie Harp were simultaneously observed by a health professional who was a certified NIDCAP Professional. A series of infants were observed with music played to their individual responses. The behavioral observations and the responses to the music were consistent with supportive regulation by the infants. Music therapy specifically targeted at longer stay infants was shown to be calming and enabled the infants to regulate their behavior. A planned music therapy program for neonates and their parents in collaboration with an experienced nurse enables the identification of infants and their families who may benefit from the program. Key Words NICU, music therapy, live music, NIDCAP, Neonate

Download Full-text

Exploring Frequency of Event Reporting as Perceived by Intensive Care Units’ Nurses in Sultanate of Oman

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.4.2021.055 ◽

2021 ◽

Author(s):

Qasim Al Ma'mari ◽

Omar Al Omari ◽

Loai Abu Sharour

Keyword(s):

Intensive Care ◽

Registered Nurses ◽

Work Environment ◽

Intensive Care Units ◽

Positive Impact ◽

Maslach Burnout Inventory ◽

Personal Accomplishment ◽

Cross Sectional ◽

Event Reporting ◽

Independent Variables

Objectives: Little is known about the factors that affect the perceived frequency of event reporting among healthcare workers especially registered nurses working in Oman. This study aimed to find out whether fatigue, workload, burnout, and work environment as independent variables have a relationship with frequency of event reporting as dependent variable and to what extent the aforementioned independent variables predict the frequency of event reporting between nurses working in different intensive care units in selected hospitals in Oman. Methods: This study used a cross-sectional research design. Also this study used standardized questionnaires which are hospital survey on patient safety culture, fatigue assessment scale, maslach burnout inventory-human services survey, NASA task load index, and practice environment scale of the nursing work index. Registered nurses working in intensive care units participated in this study from two referral hospitals in Oman during the period between June and September 2018. Results: A total of 270 nurses were included in this study (response rate: 90%). There was a statistically significant positive relationship between personal accomplishment and the frequency of event reporting (r = 0.132, p < 0.05). Regression analysis showed that nurses’ feedback and communication about errors predicted the frequency of events reporting between intensive care units’ nurses in Oman (R2 = 0.214, adjusted R2 = 0.046; F = 12.82, p < 0.01). Conclusion: Personal accomplishment and feedback and communication about error of intensive care units’ nurses had positive impact on perceived frequency of event reporting whereas no relationship found between fatigue, workload, work environment and frequency of event. Strategies need to be in place in health organizations to encourage nurses to report errors. Keywords: Burnout; Intensive care units’ nurses; Fatigue; frequency of event reporting; Work environment.

Download Full-text

Glycemic Control in Neurological Intensive Care Unit Patients

Clinical nutrition and metabolism ◽

10.17816/clinutr60533 ◽

2021 ◽

Vol 1 (4) ◽

pp. 190-196

Author(s):

Kirill Y. Krylov ◽

Ivan A. Savin ◽

Sergey V. Sviridov ◽

Irina V. Vedenina ◽

Marina V. Petrova ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Glycemic Control ◽

Critically Ill ◽

Metabolic Response ◽

Glucose Production ◽

Tight Glycemic Control ◽

Point Of View ◽

Neurological Intensive Care Unit ◽

Neurological Intensive Care

Critically ill patients often develop hyperglycemia because of the metabolic response to trauma and stress. In response to any form of damage to the organism, it reacts by increasing its own glucose production which subsequently causes hyperglycemia. This adaptive reaction of the organism is directed to aid in the rapid restoration after the damage. Therefore, glucose is an indispensable substrate in the critically ill which aids the reparation process. Severe and persistent hyperglycemia is associated with unfavorable outcomes and is considered to be an independent predictor of in-hospital mortality. The discussion remains on whether hyperglycemia is just a marker of increased stress which makes it a surrogate indicator of disease severity or if it is the reason for the unfavorable outcome. A few years ago, several published articles suggested that a tight glycemic control within the normal range improves treatment outcome. Over time, researchers have changed their point of view and currently there is a discussion on this matter in the scientific literatures. At the same time, the question of what glycemic level should be maintained for patients in the Neurological Intensive Care Unit is a matter of discussion. In this review, the authors analyzed the latest guidelines on treatment of critical patients with neurosurgical and neurological pathologies, specifically the glycemic control in this category of patients.

Download Full-text