Journal of Critical Care

PURPOSE: Few studies evaluated ICU readmission in cancer patients. This study aimed to describe the incidence and risk factors for ICU readmission in cancer patients and the association with mortality. MATERIALS AND METHODS: A retrospective cohort study at a comprehensive cancer center, which included cancer patients who were discharged after their initial ICU admission over a 5-year period. The characteristics and outcomes of patients who required ICU readmission within 30 days of discharge were compared to those who did not require readmission during the study period...

PURPOSE: The objective here is to define the extent and possible reasons for geographic variation in Pseudomonas aeruginosa associated with Ventilator Associated Pneumonia (VAP). METHODS: A random effects meta-regression model of Pseudomonas associated VAP incidence within the published literature was undertaken incorporating group level factors such trauma admission, year of publication and use of bronchoscopic sampling towards VAP diagnosis. RESULTS: Pseudomonas associated VAP incidence was reported in 162 studies from seven worldwide regions published over 30 years...

OBJECTIVE: The Surviving Sepsis Campaign and Centers for Medicare and Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1) recommend rapid crystalloid infusion (≥30 mL/kg) for patients with sepsis-induced hypoperfusion or septic shock. We aimed to assess compliance with this recommendation, factors associated with non-compliance, and how compliance relates to mortality. DESIGN: Retrospective, observational study. SETTING: 1136-bed academic and 235-bed community hospital (January 2015-June 2016)...

PURPOSE: To evaluate the effect of direct hemoperfusion with polymyxin B immobilized cartridge (DHP-PMX) on meropenem pharmacokinetics in critically ill patients with sepsis requiring continuous venovenous hemofiltration (CVVH). MATERIAL AND METHODS: After intravenous infusion of 1 g meropenem over 3 h repeated every 8 h for at least 3 doses, 2 serial blood and ultrafiltration fluid samples were collected: one over a dose interval of meropenem with DHP-PMX therapy; and the other on the following day over a dose interval of meropenem with no DHP-PMX therapy...

BACKGROUND AND AIM: Due to limited data on invasive mould infections (IMIs) in the intensive care units (ICUs) of developing countries, we ascertain epidemiology and management of IMIs at 11 ICUs across India. METHODS: Consecutive patients with proven or probable/putative IMIs were enrolled during the study period. Subjects were categorized into classical (neutropenia, malignancy, transplant recipients on immunosuppression) and non-classical (chronic obstructive pulmonary disease, diabetes, liver disease and glucocorticoids) risk groups...

PURPOSE: Intensive care unit (ICU) admission triage occurs frequently and often involves highly subjective decisions that may lead to potentially inappropriate ICU admissions. In this study, we evaluated the effect of implementing a decision-aid tool for ICU triage on ICU admission decisions. METHODS: This was a prospective, before-after study. Urgent ICU referrals to ten ICUs in a tertiary hospital in Brazil were assessed before and after the implementation of the decision-aid tool...

PURPOSE: Many patients in the Intensive Care Unit (ICU) die after a decision to withhold or withdraw treatment. To ensure that for each patient the appropriate decision is taken, a careful decision-making process is required. This review identifies strategies that can be used to optimize the decision-making process for continuing versus limiting life sustaining treatment of ICU patients. METHODS: We conducted a systematic review of the literature by searching PUBMED and EMBASE...

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PURPOSE: Patients with extracorporeal life support (ECLS) are at risk for hemolysis-related complications. Therefore, monitoring of free hemoglobin (fHb) levels is indicated. Conventional methods for fHb are laborious and not always available. Here we evaluated the suitability of the hemolysis-index (H-index), an internal quality control parameter of clinical chemistry platforms, as a clinical parameter for ECLS patients. MATERIALS AND METHODS: The performance of the H-index assay was evaluated using standard procedures...

PURPOSE: We hypothesized that item response based assessment of physical reserve preceding ICU admission is a predictor of survival. METHODS: We evaluated physical functioning using the Academic Medical Center Linear Disability Score (ALDS) and quality of life using the first question (SF-1) and the physical component score (PCS-12) from the Short-form 12 (SF-12) before admission by patients or by close proxies within 72 h after ICU admission during 1 year. RESULTS: We developed four logistic regression models to predict 1 year mortality using the predictors age, gender, ALDS, SF-1, PCS-12...

Hemoglobin-based oxygen carriers (HBOCs) are used in extreme circumstances to increase hemoglobin concentration and improve oxygen delivery when allogenic red blood cell transfusions are contraindicated or not immediately available. However, HBOC-induced severe pulmonary and systemic vasoconstriction due to peripheral nitric oxide (NO) scavenging has stalled its implementation in clinical practice. We present a case of an 87 year-old patient with acute life-threatening anemia who received HBOC while breathing NO gas...

PURPOSE: Relatives of patients admitted to the intensive care unit (ICU) with out-of-hospital cardiac arrest (OHCA) may suffer from adverse psychological outcomes. We assessed prevalence and risk factors for depression and anxiety in such relatives 90 days after ICU admission. MATERIALS AND METHODS: This study included consecutive relatives of OHCA patients admitted to the ICU of University Hospital in Basel, Switzerland. Relatives were interviewed upon admission regarding psychosocial risk factors and satisfaction with communication...

PURPOSE: Measurement of antibiotic concentrations is increasingly used to optimize antibiotic therapy. Plasma samples are typically used for this, but other matrices such as exhaled air could be an alternative. MATERIALS AND METHODS: We studied 11 spontaneously breathing intensive care unit patients receiving either piperacillin/tazobactam or meropenem. Patients exhaled in the ExaBreath® device, from which the antibiotic was extracted. The presence of antibiotics was also determined in the condensate found in the device and in the plasma...

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Mortality of patients treated on the intensive care unit suffering from cancer is high, especially when admitted with an unknown malignancy. Still, anti-tumor therapy in critically ill patients requiring mechanical ventilation is a clinical challenge. Over the last years, successful chemotherapy has been reported, even in critically ill patients with infections and organ failure. In this report, we present a 42-year old male patient who later was been diagnosed for a highly-malignant lymphoma (Burkitt) developed an abdominal compartment syndrome due to ileus, ascites and progressive intestinal tumor manifestation...

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No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

PURPOSE: To examine relationships between self-report and performance-based measures of physical function in ICU patients randomized to standardized rehabilitation therapy (SRT) or usual care (UC). METHODS: Physical function was assessed in 257 ICU patients using self-report (physical functioning scale of the SF-36 (SF-36 PFS)) and the functional performance inventory-short form (FPI-SF) as well as performance-based measures (Short Physical Performance Battery (SPPB)) and muscular strength (MS)...