Science topic
ICU - Science topic
An Intensive Care Unit (ICU), also known as a Critical Care Unit (CCU), Intensive Therapy Unit or Intensive Treatment Unit (ITU) is a special department of a hospital that provides intensive-care medicine. Intensive Care Units cater to patients with the most serious injuries and illnesses, most of which are life-threatening and need constant, close monitoring and support from specialist equipment and medication in order to maintain normal bodily functions.
Questions related to ICU
This question seeks to understand how implementing evidence-based nursing practices can enhance infection control in critically ill patients in the ICU. Infection prevention is a crucial aspect of nursing care in intensive care units, where patients are highly vulnerable to healthcare-associated infections (HAIs). Exploring strategies such as hand hygiene protocols, aseptic techniques, and adherence to infection control guidelines can provide valuable insights into reducing infection rates and improving patient outcomes. Contributions based on clinical experiences, research, or case studies are encouraged.
Are you a qualified health professional working in the acute adult setting? If yes, then we want to hear from you!
Link to survey: https://q.surveys.unimelb.edu.au/jfe/form/SV_aWORJRowoBvxC1U
We invite all qualified health professionals working and/or doing research in the acute adult hospital setting (both ICU and acute wards/floor) to participate in our study being led by PhD candidate Dominic Truong understanding how skeletal and respiratory muscle ultrasound is currently being used by qualified health professionals within the international acute adult hospital setting. Please note we are not investigating lung ultrasound. We are hoping to hear from you regardless of muscle ultrasound experience.
It is anticipated that this survey will take approximately 15 minutes to complete. Eligible participants will have the chance at winning 1 of 2 International VISA gift cards to the value of $125 AUD equivalent.
We are all living in a strange era since last year due to the pandemic of COVID-19, so we are all seeking to find the truth about basic parameters of it.
As everybody knows, any research needs reliable data, so we need data.
But, despite the plethora of available online sets, the critical ones are not always presented publicly.
For example in Greece we do not have online data for next categories, all related to COVID-19:
- daily confirmed cases by vaccination status (vaccinated-partially vaccinated-non vaccinated)
- daily deaths by vaccination status (vaccinated-partially vaccinated-non vaccinated)
In Greece we do not have also next data online:
- number of patients in simple hospital beds or in ICU by vaccination status (3 cases)
- deaths of patients in simple hospital beds or in ICU by vaccination status (3 cases)
The only available set was next:
The webpage is down, but you can see its cached version by Google:
Recently a paper about inside and outside ICU mortality was published with correspondent author having next past jobs
- 2020-02 to 2020-08 | Head of Department (Department of Database Design, Statistics and Data Management)-National Public Health Organization
- 2019-05 to 2020-02 (Office of Scientific Advisors)-National Public Health Organization
- 2017-01 to 2019-05 (Office of Scientific Advisors)-Hellenic Centre for Disease Control and Prevention
- 2014-04 to 2017-01 (Department of Epidemiological Surveillance and Intervention)-Hellenic Centre for Disease Control & Prevention
(All those jobs were at the same Organization, now called "EODY", which is the Greek CDC for all of you that you do not know the Greek reality)
Now we find a paper that uses detailed data from all ICU in Greece.
- Where is the raw data used for that?
- Why nobody else has access to that?
- Is it coming from a Public Organization or not?
Not to make you tired:
- Do you think it is ethical for a scientist to use its exclusively access to COVID-19 data set for making private scientific research?
- Do you agree that all data for COVID-19 that wre collected from public authorities should be open accessed by anyone online?
Thank you for your patient to read such a big test,
I am waiting for your thoughts,
Demetris
My name is Anna Hanson, and I teach nursing at the University of Texas. I was an ICU Nurse Manager previously, and am very interested in the experiences of others as they manage their own ICUs. I am doing my dissertation for my PhD at UTMB, and am talking to ICU Nurse Managers to see what challenges they face, and what they enjoy about their jobs. I want to see things to share with others to help other nurse managers. My study is IRB-approved and these conversations are completely confidential.
I wanted to see if you would be interested in a phone call or zoom call to discuss your experiences. Again, these conversations are private, and I mask everyone’s identity.
I would appreciate any consideration of speaking to me. You may respond back to this email if you would like to speak to me.
Thanks again!
Anna Hanson
can somebody send me the latest updated guidelines for feeding or nutrition post cardiac surgery in paediatric cardiac ICU
It is known increasingly that Diabetes Mellitus Type1 patients who do survive the Omicron variant of Covid-19 are falling in and out of DKA (Diabetic KetoAcidosis). They are increasingly insulin resistant. CO2 and Glucose levels become "critical" on labs. Blood Glucose can range from 782 - 1,000 - YES... and Sodium, Potassium and Chloride levels peak and yet, according to the ICU physicians, the HIGH Potassium ex:5.5 is "lying to the Glucose" to trick it during this *game of chess.
Check it out. Fascinating!
Many ICU beds had no technical body weight measurement for Patient who need daily care and assessment for body fluid retention and fluid , electrolyte disturbance
The question What is the appropriate method or technique that useful for body weight measurement for unconscious Patient..
I have tried to install phyloseq in R 4.0.1. I checked my packages and could see it but when l try to import_mothur l get this error:
Error: package or namespace load failed for ‘phyloseq’ in inDL(x, as.logical(local), as.logical(now), ...):
ICU init failed: U_FILE_ACCESS_ERROR
In addition: Warning message:
package ‘phyloseq’ was built under R version 4.0.3
Could anyone help me with this issue.
Hi everyone,
ICU nursing staffing's impact on patient (and other) outcomes is well documented in the literature. Nonetheless, methods (e.g. Nursing activities score) have been criticized during the last decade for not including several aspects of the nurse's work besides bedside duties.
Currently, which would be the most valid approach /tool to objectively estimate nursing staffing?
I am working on a model to capture data from monitors in ICU and send it to doctors if their patients were in danger
Hello. For our research study on determining laboratory tests which has prognostic values in COVID-19 ICU patients, we divided our data from admission, 3-5 days hospitalization, and composite endpoint. Do you have literatures that may help us address the problem wherein 2 or more values are performed in the admission. We wanted to only record one data for this. Do you have literature that says we can get its mean, or probably get the earliest or the most recent value? Thank you
The question I am trying to solve for my graduate assignment.
I have a group of people (Doctors, nurses, and other providers in the hospital, who were trained by a team of non-specialists ( pre-group) and a group that a specialist trained ( post group) on how to treat alcohol withdrawal in the hospitalized patient effectively. Both pre and post group used the same tool (scale from 1-67—the higher the number, the more severe the withdrawal. I divide the CIWA score into a range: Mild moderate. Severe and extreme. (AWS severity) . The nurse in the hospital assesses the patient in the hospital with the CIWA score. If higher than 7, the nurse calls the doctor, and medicine is prescribe. There is a policy for this. The assumption is that the earlier you treat, the less possibility of severe withdrawal, as evidence by the lower Ciwa number, throughout the patient's hospital stay. If the patient continues to have scores higher than16, the patient is transferred to the Intensive care unit (ICU) from the non-icu floor ( Medsurg).
I would like to see if a standardized training of the alcohol withdrawal protocol at a local hospital, improve patient outcomes ( decrease worsening of AWS symptom), as evidenced from CIWA score (range); decrease ICU upgrades; decrease the length of stay (LOS) compared to a non-standardized training of the CIWA protocol? (Pre and post)
CIWA scoring. Mild ( 1-8) Moderate (10-15); Severe (16-21). (22-67) extreme. All coded in SPSS with numerical value 0,1,2, etc.
The issue: I imported the data from Excel in the statistical program IBM-SPSS using either the independent t-test, Mann-Whitney you test, or a few, which all failed the analysis.
My professor wrote me this.
.
The outcome variables for CIWA scoring are ordinal, not continuous, so you’d want to use an ordinal logistic regression. The model would have a score as the dependent variable and CIWA (pre vs. post) as the independent variable. Exponentiate the slopes with 95% of their CI, and you'll have the odds ratios (and 95% CI) that reflect the fold-increased probability of going to a higher level on the ordinal scale after the CIWA training. Make sure that proportionality assumption holds for your fit model, and if it doesn’t, use multinomial logistic regression instead that considers these as categorical variables but is less powerful.
Upgrades to ICU are binomial outcomes, so they would be analyzed using standard logistic regression. Upgrade Y or N) would be the outcome, and CIWA would be the independent variable
Length of stay is an integer type value and can be analyzed with several techniques but I’d use quantile regression and report the data as medians and ranges.
Frequency (or contingency) tables where the data are strictly categorical can be analyzed using Chi^2 test or (or Fisher’s exact test if the expected frequency of a cell is less than five and it’s a 2x2 table). Still, I find these analyses not to be as helpful as regression techniques. Such tests give the same results as regression techniques. Still, they only tell you that the counts are not distributed randomly across the table, and it can be hard to explain how they differ (regression methods tell you that they differ and by which variables).
Even though means could work, I would still use medians and ranges to describe length of stay because that is an integer variable that is measured in whole numbers. If no one staying for part of a day, when you average the results you'll get things like cases differed from control by .234 days (P = 0.02) that are hard to interpret. Medians are also less affected by extreme values than means so that 1 patient that stays won't have as much influence as they would otherwise.
I would also like to know how far is it possible to follow the principles of ABS using pharmacokinetic & Pharmacodynamic model in ICU ?
I was asked to give suggestions for the equipment list for ICU up-gradation. The ICU shall be catering to predominantly medical and mostly respiratory cases. I could think up of NAVA ventilators, Esophageal pressure monitors, and stuff. Although I am not sure of the cost-benefit ratio of NAVA ventilators. Could I get some suggestions on cutting-edge tech for a majorly respiratory ICU?
I am a Neonatal Sister who is collating a file on Nutrition and Hydration for use in a Neonatal Unit that admits from 23 weeks gestation. Do you have any helpful info for me?
Thank you so much
Su Samuels
Feeding Lead Nurse
Considering the huge oxygen supply shortages specially during Covid 19 pandemic, breathing circuit which consumes less oxygen and meets the patient's needs for oxygen is something which we should be looking forward to. We have used circle system for decades in operation theatres and we are now becoming more and more trained in using low flow Anesthesia with the help of Co2 canister and scavenging system. This helps for environment of it room as well. Even modern ICU ventilators don't have a scavenging system and depletes a large amount of oxygen from hospital source.
This is why what occured to my mind as why not incorporate the circle system with scavenging into the ICU ventilators itself with some modifications which could suit for the ICU ventilator.
Limitations:-
1) there can be some modes of ventilating the patient in ICU ventilators in which circle system may not be useful, however with required modifications to suit a the modes it can be made.
This needs a good clinical engineer who understands the parts and physiology of how machines and breathing system of a human body works. This sure would be a great idea to work upon which could reduce the oxygen consumption significantly. This is because most ICU ventilators at minimum use 7-8 litres per minute of oxygen whereas Anesthesia ventilators with the help of closed circle breathing system , oxygen consumption can be used to a minimum of 1-2 litres per minute. This happens due to exhaled gas from the patient passing through the canister containing co2 absorber such as soda lime and the same gas is rebreathed by the patient.
In conclusion, incorporating closed circle system in the modern ICU ventilators is something to look forward to in the context of eye opening oxygen shortages happening in this COVID 19 crisis.
I have been active in a European research project the VIP= Very old Intensive care Patients and since the start of the pandemic we have had a prospective study running in elderly COVID-19 patients in the ICU. We constantly have been surprised by the lack of good evidence for core issues in intensive care for the elderly, and suggested a research agenda back in 2017 (https://doi.org/10.1007/s00134-017-4718-z). Our task has first and foremost been concentrated on various outcomes and explanatory variables. We have recently also started to find peculiar trends in the treatment of the elderly Covid-19 patients. Our data suggested that they had en excess mortality during the second surge, and also that it seems that systemic steroids given to this group may result in increased mortality, on contrast to the less old COVID-19 patients. It would be good to start a discussion about this, and feel free to comment and suggest other issues related to this topic.
You can also have a look at our web-page if you are interested in contribute (https://vipstudy.org/)
Hans Flaatten
For the acute resuscitation of adults with COVID-19 and shock, the current recommendations are suggesting, using buffered/balanced crystalloids over unbalanced crystalloids.
The purpose of this discussion is address the need for guidance on fluid resuscitation among severe COVID-19 patients and shock management in resource-limited settings
In Germany the minister of Health wants to drop the incedence, the number of new infect Io ns per 100 thousand people, as the major indicator to take policy decisions to contain the pandemic in Germany. The president of the RKI has protested to do this.
Who is right?
I think the incedence is still an important leading indicator to judge the actual development. The attempt to replace it by the share of ICUs occupied by coronavirus patients is wrong.
First, the is a lagging indicator compared to the current incidence. Causality runs from infections toward hospitalizations not the other way round.
It is true in particular through vaccinations over time the relation between both indicators has changed, but this could be modelled using Kalman-Filtering techniques including variable coefficients.
Using such estimates to predict the future share of ICUs occupied by the corona-patients would be more efficient than just looking at the actual ICU shares.
What do you think?
Common sense suggests that quarantine centers or ICU's where COVID patients are being treated have a high probability of transmission of virus especially to those providing assistance (doctors and nurses). My question here is there a measure to qualitatively or quantitively describe the air ( primary source of the virus spread) quality like PPM. If so how is the air quality in COVID affected areas different from COVID ICU's and how does it compare to COVID free areas. Can anyone please provide information or relevant literature on this topic.
Thanks in advance.
Seizures are fascinating intellectually, but they can be devastating for the person suffering from them. We have all heard stories of young people who seemingly have no genetic or other past medical history and present to the Neurological ICU in status epilepticus -- an entity known as NORSE. All our algorithms fail and we are left scrambling for effective approaches without any evidence. Often, despite our best interventions, these young healthy patients have >35% mortality rate. And those that survive rarely make it past the SNF.
We have one such patient in our Neurological ICU currently. So I wanted to ask what you guys do when the standard treatments have failed? Per the American Epilepsy Society guidelines, we initially treated her status with Ativan, Midazolam, Keppra loads, Vimpat loads, Fosphenytoin loads, Versed drips, and finally Pentobarbital coma. Currently she is on Keppra, Vimpat, Fosphenytoin, Felbamate, Epidiolex, and Fycompa. Thankfully the Pentobarbital is now off, but she continues to require continuous Versed drip.
In your experience, have you found anything effective in these situations?
SARS COV2 while still burning through the US, we and other nations have researched practically every topic that this Virus could have. Everything from the Spike Protein on the surface binds to our ACE2-R to the Disseminated Intravascular Coagulation, also known as (DIC). One of the research topics that caught my eyes was the Comorbidities leading to serious outcome cases and unfortunately death.
Mississippi Statistical data shows the number one cause for serious complications and is common comorbidity is Hypertension (HTN) and related cardiovascular disease (CVD), (MSDH, 2021). That said, the problem surrounding HTN and CVD is the increased expression of ACE2-R, thus leaving subjects with increased susceptibility to not only more infection but certainly increased shedding of the virus. This overexpression of ACE2-R is a popular subject in many think tanks and schools of thought.
One would surmise that other comorbidities would have similar if not worse increases in ACE2-R in SARS COV2 infection. Asthma and Chronic Obstructive Pulmonary Disease (COPD), in particular, has a risk in that the pulmonary system is compromised pre-infection which you would think would be a good predictor of severe case outcomes and death. Researchers from the Journal of Immunology and Clinical Immunology found that indeed this was not the case. Interestingly, asthma, COPD, inhaled corticosteroid treatment, and oral corticosteroid treatment were not independent risk factors for ICU admission or death, (Calmes, 2021). Please read the Journal Articles below for your enhanced SARS COV2 knowledge and education.
References:
Calmes, D., Graff, S., Maes, N., Frix, A. N., Thys, M., Bonhomme, O., Berg, J., Debruche, M., Gester, F., Henket, M., Paulus, V., Duysinx, B., Heinen, V., Dang, D. N., Paulus, A., Quaedvlieg, V., Vaillant, F., Van Cauwenberge, H., Malaise, M., Gilbert, A., … Schleich, F. (2021). Asthma and COPD Are Not Risk Factors for ICU Stay and Death in Case of SARS-CoV2 Infection. The journal of allergy and clinical immunology. In practice, 9(1), 160–169. https://doi.org/10.1016/j.jaip.2020.09.04
Nawijn, M. C., & Timens, W. (2020). Can ACE2 expression explain SARS-CoV-2 infection of the respiratory epithelia in COVID-19?. Molecular systems biology, 16(7), e9841. https://doi.org/10.15252/msb.20209841
best method to control Mucor mycosis at a ICU set up especially is cases of COVID19 patients?
A comparison between Thoracic epidural, Intercostal nerve block and Paravertebral nerve block in terms of their limitation, efficacy, side effects etc.
ICU patients who are receiving invasive mechanical ventilation and noninvasive ventilation often require sedation and analgesia. COVID-19 pneumonia / ARDS induced acute respiratory failure patients are not indifferent in this aspect. Sometimes, it also feels that these patients need more sedation, even on NIV. I shall be delighted to know the sedation practices, drugs, single or combinations you are using in your set-up.
What is your practice/research reading about Early Vs. Late Intubation in COVID-19 Patients? how you define early vs. late? Is there any evidence to intubate early to save lives in COVID-19 patients?
We are planning to begin using nitric oxide on our cardiac surgery CABG patients. I would like to know if there is risk to pregnant ICU nurses caring for the the patient if she inhales any of the nitric oxide.
Multi-modal monitoring for malignant cerebral edema, increased ICP, and other conditions is rapidly gaining favor amongst our Neurological ICU and Neurosurgery community. Thus far, no standard of care has been established. And the data collected from intracranial device monitors such as the Licox and depth electrode EEGs have variable clinical significance. Regardless, the trend will likely continue.
A host of new devices now promise use of infrared and other technology for noninvasive multi-modal monitoring. If proven with accuracy, this would not only be superior to intracranial monitors due to lack of infections and other concerns, but could also being this possibility to a host of patients who have contraindications to or do not want neurological surgery.
I am curious what devices you are using at your institutions and how has your experience been so far? Specifically, do you feel the noninvasive device is as accurate as the current intracranial devices and do you have data correlating the two to affirm this?
A large majority of intracerebral hemorrhages, especially in younger patients, are due to hypertensive emergency. Often, these patients will get started on a titratable continuous IV drip medication like Nicardipine in the emergency room. However, there was a recent paper in Neurocritical Care journal that suggests that starting oral antihypertensives in conjunction during this very acute stage can lower morbidity, costs, and hospital/ICU stays. The rebuttal is of course that blood pressures on oral antihypertensives are subject to peaks and troughs with medication administration until steady state is reached. During this time, overshooting the target and causing hypotension can cause significant ischemia to surrounding cellular tissue that may be amenable to rehab, and hence worsening long-term outcomes [though this has not yet been systematically analyzed]. What is your opinion on this?
Participating in an ICU based study looking at intubated and ventilated COVID patients first out of bed rehabilitation session with Physiotherapists and trying to determine if it is safe by using group analysis to analyse physiological parameters such as systolic and diastolic blood pressure, heart rate and oxygenation. Currently very little data on what the MCID to determine how much of a change in these parameters would be clinically important that may determine if rehabilitation is safe for this patient group.
Any help would be greatly appreciated.
Participating in an ICU based study looking at intubated and ventilated COVID patients first out of bed rehabilitation session with Physiotherapists and trying to determine if it is safe by using group analysis to analyse physiological parameters such as systolic and diastolic blood pressure, heart rate and oxygenation. Currently very little data on what the MCID to determine how much of a change in these parameters would be clinically important that may determine if rehabilitation is safe for this patient group.
Any help would be greatly appreciated.
What are the major differences in ICU admissions during the first and second COVID_19 wave?
ICU addmissions ,COVID_19 Waves ,Differences.
The coronavirus pandemic has been hard on the whole world. However, some countries and places have been affected by way more than others. COVID-19 has always been reported to have a high risk of contraction and complications among the elderly. However, in the second wave of COVID, ICU admissions among the young have increased in many countries.
Your viewpoints :)
This question refers to the issues that nurses face when they are caring for patients with COVID-19 on isolation protocols ,and which triaging methods you use in your medical facility?
I am looking forward your replies,
I will try to summarized most important points regarding thromboembolic events in COVID-19 patients:
* 1/3 of patients with covid-19 in ICU have reported venous thrombo-embolism (despite prophylactic anticoagulation)
* 3/4 of patients were male.
* Most of venous thrombo-embolism events were pulmonary embolisms.
* Common in COVID-19-associated acute respiratory distress syndrome (ARDS) to a matched cohort of 145 patients with non-COVID-19-ARDS (12 versus 2 percent).
* Some experts suggest more aggressive thrombo-prophylactic dosing of anticoagulants or even empiric therapeutic dose anticoagulation for VTE prevention .
* Data are more limited regarding the rate of VTE in inpatients who are not in the ICU.
* Venous thrombo-embolism events in COVID-19 patients have been observed in outpatient and non-ICU inpatients but it is less than ICU patients and data regarding this issue are more limited.
* Arterial thrombosis are also reported e.g. acute ischemic stroke (patients were under 50 years of age), myocardial infarction and peripheral arterial thromboembolism.
* Microvascular thrombosis are also reported in autopsy studies of the lungs and mechanism is unclear (may involve hypercoagulability, direct endothelial injury, complement activation, or other processes). So, testing for thrombotic microangiopathies (eg, ADAMTS13 activity, complement studies) or specialized therapies (eg, plasma exchange, anti-complement therapy) are not recommended without a research study.
* Bleeding is less common than clotting in patients with COVID-19 and usually seen in the setting of anticoagulation).
I hope this could help you to provide better care for your patients.
Regards,
Abdul Hadi Al-Qahtani, MD/MHA
I have an ICU patient who is known to have ESBL-producing E. coli colonisation detected on numerous rectal swabs in prior admissions. Now, he has E. coli bacteremia with isolates not ESBL-producing. How is this possible? What could be the likely source of his bacteremia? He has no wounds. Thank you in advance for sharing your knowledge.
Two weeks since cardiac arrest with 30 min CPR and ECMO. Unresponsive with clinical coma. Blinking spontaneously. Do you see the missing AP gradient. What would be your assessment from now.
ICU patients, after a severe COVID-19 disease, always incur long-term damages?Which are the most frequent ones?
Thanks for the support.
The challenge is to create a model that uses data from the first 24 hours of intensive care to predict patient survival . My dataset has more than 130,000 hospital Intensive Care Unit (ICU) visits from patients, spanning a one-year timeframe.
Please point me to sites where I can find relevant research papers.
Thanks
Does anyone have a clue about the significant differences in mortality rates in COVID infected people between Germany and other countries (Spain, Italy, France…)?
Germany is a densely populated country (86 000 000 inhabitants in just 360 000 square kilometers), with several very populated cities. Nevertheless it is not being hit by COVID as hard as other countries. Are German doctors treating patients in a different way?
I know that probably the explanation is complex:
1. Germans as Oriental people, may be more disciplined than Mediterranean people, and that could justify a slower spread of infection. There may be genetic differences.
2. Probably there are differences in the definition of infected cases and COVID mortality. We know that they have made more PCR tests so their definition of case is wider, and that could explain lower relative figures (number of deaths per each infected people). But absolute figures are also lower. On the March 22th they had only registered 68 COVID deaths.
3. The number of ICU beds could explain some differences (with 28,000 ICU beds, Germany is the first in the ranking of ICU beds (6 ICU beds per 1,000 inhabitants), while Italy has 2.6 ICU per 1,000 inhabitants and Spain only 2,4). (https://www.euronews.com/2020/03/19/covid-19-how-many-intensive-care-beds-do-member-states-have)
4. They could be in an earlier phase of the epidemic. So the figures could worsen in the next days.
In any case they seem to have less severe cases. There may be biological differences between different populations. Still the differences in the absolute figures are really striking.
I would like to open a debate about the standard treatment in Germany vs the standard treatment of COVID infection in other countries.
Are they doing something different?
Is there something we should learn from them?
Best regards from sad Spain.
Julio.
I am interested in drug resistant strains.
Chiumello et al (2006) suggested that thorax and pelvic supports should not be used in prone patients lying on air mattress beds in the ICU. The supports did not significantly affect intra-abdominal pressure and increased the likelihood of pressure sores.
Do you support the chest and pelvis at all when your patients are prone on air mattresses in ICU? And if you do, what do you use - and why?
Hi all,
I'm currently preparing RBC aliquots (100μl) from ICU blood samples and I'm looking for a method to determine the qualitative amount of RBCs in every sample to decrease the pipetting error.
As the title mentioned, we had been preparing the worst scenarios , should we shutdown some regular ICU beds to free mechanical ventilators or should we keep the same numbers and setting patients in isolations with Transport Ventilator( IMPACT EMV+) continuously .
Wards/Beds are available, but equipment arrangement have to be prioritised. Safety is crucial as well. Report from vendor is that once there's continued power inlet, transport vent can be used 24/7 for adult usual ventilation but not defined the settings eg.ARDS high PEEP with difficult ventilation patients cohort.
I currently have the WHO, the Chinese, and the German guideline for SARS induced by corona virus. I mean management in the ICU.
Can anybody contribute a respective Italian or Spanish guideline?
With the new COVID-19 outbreaks and shortages of N95 masks: what are the alternatives for the healthcare workers (doctors, dentists, nurses, RTs) who may be in close contact with potential COVID-19 patients?
Would you recommend putting a regular surgical mask and face shield on top of it?
Suggestions with scientific rationale are welcome...
Here is a question for everyone that I am currently stumped on:
Is there some standardized metrics or quality targets for in-hospital cardiac arrests rates?
Its related to the work I am doing to implement CCOT at SPH. The CCOT literature uses a variety of measures and it gets a little confusing:
· Code blue (all types) per 1000 admissions or per 1000 discharges
· Cardiac Arrest (only code blue with CPR) per 1000 admissions or per 1000 discharges
· Code blue or Cardiac arrest excluding critical care areas (i.e., ED, ICU, CCU, CSICU, OR/PACU) per 1000 admissions or discharges
I looked through CIHI and it does not look like they have any stats on in-hospital cardiac arrest rates that I could find. We keep track of code blue data, but I don’t think it is reported to any external organizations. The UK and Australia have done rapid response systems for far longer, but I haven’t come across any official standardized metrics or definitions of what is considered good, bad or ugly in the way of targets.
Thoughts?
Thanks in advance for any assistance you can offer.
Vini
Hi all,
I want to perform a study in ICU/Oncology with my fellow Clinical Pharmacists. I am very happy to hear from you regarding the research topics which I can go for
I have two datasets:
One dataset is on patients' daily Blood Pressure measurement (there may be missing data depending on consent each day) and patients unique ID
And other dataset is with patient's unique ID and Date admitted to ICU (only some of the patients are admitted to ICU).
Using this unique identifier (Variable unique ID - common in both datasets), I need to link these two datasets to identify:
Among those admitted to ICU (i.e. only those IDs with date admitted to ICU)
How many days in the 2 weeks before, and the 4 weeks after the index date (date admitted to ICU) does that that patient have given Blood pressure data.
Any suggestion on how to generate a syntax for finding this information in Stata please?
Thank you.
Anyone interested in exploring novel ways of monitoring the appropriate position of endotracheal tube (ETT) in mechanically ventilated ICU patients?
Traditionally this is done with repeated Chest X-rays. What about researching new available technologies, like ultrasound or wireless methods, without the potential hazards of repeated radiation?
According to the Centre for Disease Control and Prevention (CDC), additional consideration should be given to patients with Multiple Drug Resistant Organisms (MDROs) in ICUs using measures that include single room isolation and dedicated specific staff to provide the bulk of the patient’s care rather than all staff available.
If single rooms are not available to isolate MDRO positive patients then the use of cohorting is advised, meaning that these patients should be grouped with others who have cultured positive with the same organism(s).
But, Isolation and cohorting is not always feasible to achieve.
So. When MDRO positive ICU patient isolation and cohorting is not feasible, what comes next?
While more than half of the ICU patients have either sepsis/infection or are on antimicrobial - How we practice infectious diseases differ significantly between an ICU and other even in the same country (sometimes even different ICUs in the same hospital).
Understanding such practice is fundamental to improve patients' outcome, antibiotic resistance, length of stay, morbidity as well as antimicrobial resistance.
Can you help by answering this survey:
Occasionally we used to have transcutaneous CO2 monitors for selected ICU patients, especially those who are ventilated with HFOV.
However, with its poor correlation with the blood gas analysis and the complications of the electrode site burns, I think it is out of fashion?
Is anyone using similar products with better clinical experience?
As compared to the "traditional" intracoastal chest tube that are inserted at the bed side for ICU patients to drain pneumothorax / pleural effusion. In the last years some ICUs have been using the newer "Seldenger" over the guide wire technique.
Which style do you prefer? Why?
Is your setup Adult / Pedia or Neonatal ICU?
Post intensive care syndrome (PICS) is very common, primary care doctors have little or no help from us intencivist in taking care of these patients post critical illness recovery and discharge from ICU. Being an intencivist I think our main focus is to save lives and act acutely. But I think there is little or no focus on post critical illness and we should have special clinics for these patients.
In my clinical practice I have seen many nephrologist ordering renal usg in AKI patients, but current literature does not support it.
What do you practice in your ICU ?
For those connected with the ICU settings : Do you routinely send tips of removed central lines for culture?
Is identification of the biofilm from these lines helping?
through out my training I have seen continuous feed in icu critically ill patient. But normally we human beings don't eat all the time and especially at night time. Why don't we just bolus feed or feed in day at higher rate ?
We are trying to create an SMR for our ICU network. We calculated the predicted mortality for all the patients for six months and plotted an ROC for the prediction tool used. However from the tool, to generate a predicted mortality, one should have a threshold mortality percentage above which the patient will be counted as dead, right? How do we determine that threshold?
To illustrate with an example, if in an ICU with 5 admissions a month, APACHE predicted mortality for the patients are
10%, 17%, 32%, 6% and 17%
And say the observed mortality is one
What is the expected mortality here? Who do we count as dead here? Strangely none of the literature mentions about this. Could anyone please shed some light in here.
Thank you so much.
I am a recently qualified HCPC clinical scientist looking to start publishing papers. I specialise in critical care across paediatrics, neonates and adult ICU. I am looking for suggestions of journals that are related to healthcare science rather than intensive care.
There's a new type of antibiotic prophylaxis for severerly burn patients in ICU.
My thesis will be about introducing this new regimen to a Hospital.
There's a recent systematic review providing evidence about how this prophylaxis lowers mortality.
My question is: what is necessary to include in the thesis? Is it necessary to write a new systematic review that shows evidence about its results?
Hello
My name is Luis and I am working in emergency laboratory in Santa Lucia Hospital, in Cartagena (Spain)
We have investigated about PSP in adults ED and in febrile neutropenia (paper is going to be published In Clin Chem Lab Med). Now we are writting a paper about prognostic value of PSP in ICU patients with sepsis. Are you investigating about PSP?
My e mail is guadianarom@yahoo.es
Best regards
Dear,
My name is Noemi Giannetta; I am Italian PhD student at the Tor Vergata, University of Rome. I am writing to ask you if you are interested to partecipate to an international study about medication errors in ICU (intensive Care Unit). It is a study conducted for Tor Vergata University of Rome and Sapienza University of Rome. The aim of this study will be to assess knowledge, attitudes and professional behaviour of Italian and “international” nurses towards preparation and administration of intravenous medications in ICUs. At the moment, Spain, Portugal and Malta are the country involved. I'm very grateful if you can help me to administrate a web survey to your colleagues in ICU (Di Muzio, Tartaglini, De Vito, & La Torre, 2016). I am very happy if you are interested to help us to publicizing of the web survey.
Graduated nurse, doing ICU course in the Netherlands.
For my final project trying to improve our NPPV protocol.
Not really lucky with finding any evidence on the naso gastric tube in NPPV.
We have used the Inventory of Callous-Unemotional Traits (ICU; Kimonis et al. 2008)
We are using the RASS scale, but that was developed for evaluating delirium and agiation in the ICU population, not a psychiatric population
Outbreak alert user friendly application
- Interaction with humans is never a one-way street. The doctor is in command while interacting with patients, but educated intelligent patients are always evaluating the motives and competence of their doctors, albeit with varying and limited success.
- The awe of specialist wears off, generally, after the first visit. The patient is hapless and helpless but not witless. Every word and mannerism of the doctor (or the stoic unemotional lack of both) conveys some meaning to the patient. This hyperacute mental state of the patient worsens with polymedicine and polytherapy and peaks in the pre-agonal stage. Woe falls on the doctor who changes medicines at each subsequent appointment or waits indefinitely for the issue to resolve by itself.
- Desperately ill and dying patients have no option. By the time DNR Wills can be produced, the end-drama plays out, frequently. You may do anything with them, insert all kinds if lines, central or peripheral, order an unending list of investigations, take a series of informed but cosmetic consents, initiate heroic invasive procedures, rush them to the ICU or place them on ventilator just to delay the inevitable without a murmur from the care givers.
- The treating doctor must realize that the boomerang curve of time could well strike her/him unpredictably but similarly.
- Is it true that what goes around, comes around?
A 80 year old female patient with normal blood sugar level but a little hyper tension has been undergoing gradual increase in the pCO2 levels. Lives in a healthy environment, but the pCO2 levels hit 100+ 2 times in the past 4 months. Every possible tests including neural conduction test have been done. But the actual cause remains unknown. When given oxygen, fast recovery is seen in the patient. Was rushed to the ICU twice. No loss of memory or speech. Early symptoms include dozing off and gradual loss of interest.
P.S - Under contrast CT, perigastric mass measuring 71X68mm was found and confirmed. Due to lack of fitness, biopsy was not done, suspected leiomyosarcoma, but no symptoms found. Looks like mass is not the cause for the above mentioned problem. Please help... Comment for further data.
My ICU is located around 1400 metres above sea level. The barometric pressure at this altitude, based upon the altitude-pressure tables, comes around 650mmHg. However, the climate authorities here mention that the measured 'air pressure' is around 1015mb, which is 760mmHg. For the same reason, the A-a gradient that we calculate in our patients is much different than that provided by the ABG machine. Can Patm at this altitude be same as that of sea level? which one do you think is preferable?
i do a prediction model using data mining classification algorithms (neural networks, SVM, RF, naive bayes, CART ,...) to predict length of stay LOS in Intensive Care unit department ICU. data sets consists of discrete variables as (gender (1,0) for male and female) also 0 value for not having specific chronic illness or complaint and 1 for occurrence. the rest of features are continuous for blood pressure, temperature, PH, Na, and K labs results. the output is three values (1,2 and 3) refers to the duration of stay in icu.
the prediction results accuracy are very low when performing the prediction using the raw data set or even after discrete and normalize (min-max) of all features.
any suggestions please?
What is the influence of AI and UX on ICU projects? Someone can instruct me on the current use of AI (architecture of the information) and UX (user experience) in the current software development.
I want to gather opinions about PACT modules by the European Society of Intensive Care Medicine!
Can somebody tell me the most common microorganism isolated from ICU?
I manage Nîmes' rehabilitative post-ICU unit (RPR - "rééducation post-réanimation" in french)
Can we be part of this database ? Do we need to be linked to Nîmes'ICU units ?
Risk factors for CRBSI are well documented but I´m looking for a sort of screening tool in ICU pacientes with CVC.
According to NCBI guideline, it is recommended to administer maintenance IV fluids required by the patient (30-40ml/kg/day) during day time to ensure good sleep for the patient and nurse. But this guideline didn't mention maximum accepted infusion rate for maintenance IV fluid !!! so how much maximum accepted rate and what are the possible complication if it is exceeded?
Is nursing care of elderly patients hospitalized in the intensive care unit differ from other hospital wards?
I am looking for model of care in the ICU for elderly patients.
I am looking forward to hearing from you. So, here you are.
In the fluid responsiveness research community, we nearly always define a fluid responder by an increase in stroke volume or cardiac output of at least 15% following a fluid challenge. We use flow as outcome for physiologic reasons.
In my experience, however, reliable flow monitoring is rarely present in the everyday clinical practice in ICUs, so clinicians often respond to e.g. low MAP levels and, thus, aim to increase MAP with their treatment (perhaps with "downstream" hopes for effects on diuresis, etc.) Clinicians rely on a variety of validated fluid responsiveness techniques (hopefully) within their limitations - Pulse pressure variation, passive leg raise, etc.
But MAP does not necessarily change the same way that stroke volume does upon fluid loading.
So, what is your experience/opinion: Do we have a relevant gap between research efforts and what is available/possible to do in (most) patients in everyday clinical practise?
dear all:
Im working now in project to test nurses knowledge regarding impact of ICU noise, So, im searching for valid tools (questionnaire) to perform this project.
Nosocomial infections are common with multiple antibiotic resistant (MDR) strains and often prove difficult to be treated. We examined hand swab of 15 medical doctors and 13 medical attendants working in medical surgeries for the presence of meropenem resistant bacteria. Of these, two doctors and two ICU attendants carried meropenem resistant MDR strains (resistant to 19 to 24 antimicrobials) of Acinetobacter baumannii (1, neurosurgeon) and Staphylococcus carnosus (3, one plastic surgeon, two ICU attendants).
Hi
I am evaluating renal recovery pattern among non-dialysis dependent AKI patients especially among patients with AKIN-I and AKIN-II stage of AKI. I am bit confuse because my outcome is renal recovery but available literature has vast variation for definition of renal recovery.
Most of the studies have been done on critically ill patients requiring dialysis. But in my case, patients have mild to moderate severity of AKI. There is no patient with dialysis in my study. So definition of dialysis independence will be excluded. On the other hand, as in my study patients are not critically ill and have less severe stage of AKI, so defining AKI as +/-25% of baseline will show that all patients have full recovery. However, most of the patients have elevated levels of Serum creatinine as compared to baseline. and I am confuse to declare them as fully renal recovery patients because I can not ignore the findings of previous studies that "small increase in serum creatinine is associated with high morbidity and mortality"
Please guide me in this regard, with appropriate reference
I am working on the prognostic value of EEG in ICU patients with altered mental status. I would like to know if I can include patients with different etiologies for altered mental state in ICU, such as traumatic brain injury, stroke, etc.
In Asian countries infections in ICU are mainly caused by gram-negative organisms like Klebsiella, Acinetobacter, Pseudomonas; whereas in European countries there is a clear trend of Staphylococcus (MRSA) causing most of the infections in ICU.
Quality Improvement group trying to improve care of deteriorating patients and deliver cost effective safe care in a large teaching hospital in the UK.
How to identify the common source of an outbreak caused by Burkholderia cepacia (bacteremic/septicemic) in an Medical ICU by a systematic investigation ?
Is there any standard comprehensive protocol available (Including Chart review and line listing and for Environmental/drug sampling) to identify the common source of an in-hospital/nosocomial outbreak among immunocompetent critically ill patients? It is quite frustrating when all cultured samples turn sterile...
I am seeking the community's help on this: Do you have any experience with validated, non-proprietary scores which facilitate physician and nursing staffing ratios. Is SOFA score an appropriate tool for this? What is your opinion about other scores such as the TISS scores, CMI scores, etc.? Any substantiated input will be appreciated.
Thank you,
Markos
I mean who choose the best Ideal mode of RRT ( SLED - CRRT - IHD ) for the patients ? Is there any RRT team in your hospital or nephrologists reply the consultation ? or ICU men ?
SLED : sustained low efficacy daily dialysis
CRRT : continuous renal replacement therapy
IHD : intermittent hemodialysis
Hello!
I believe most of you must have read the new definitions of sepsis and septic shock published in the "JAMA" latest issue. A new definition in which the SOFA score becomes a diagnostic tool and not just a prognosis-assesment one.
The score in itself is quite easy to use but when it comes to the GCS, what should one do? Most of ICU patients or those with septic shock are sedated. How can we evaluate the GCS then, should we always use the last GCS measured before sedation, or should we assign a random medium number in such cases??
Many thanks for your insight.
