Context Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. However, relatively little information is available about the global epidemiology of such infections. Objective To provide an up-to-date, international picture of the extent and patterns of infection in ICUs. Design, Setting, and Patients The Extended Prevalence of Infection in Intensive Care (EPIC II) study, a 1-day, prospective, point prevalence study with follow-up conducted on May 8, 2007. Demographic, physiological, bacteriological, therapeutic, and outcome data were collected for 14 414 patients in 1265 participating ICUs from 75 countries on the study day. Analyses focused on the data from the 13 796 adult (>18 years) patients. Results On the day of the study, 7087 of 13 796 patients (51%) were considered infected; 9084 (71%) were receiving antibiotics. The infection was of respiratory origin in 4503 (64%), and microbiological culture results were positive in 4947 (70%) of the infected patients; 62% of the positive isolates were gram-negative organisms, 47% were gram-positive, and 19% were fungi. Patients who had longer ICU stays prior to the study day had higher rates of infection, especially infections due to resistant staphylococci, Acinetobacter, Pseudomonas species, and Candida species. The ICU mortality rate of infected patients was more than twice that of noninfected patients (25% [1688/6659] vs 11% [ 682/6352], respectively; P  Conclusions Infections are common in patients in contemporary ICUs, and risk of infection increases with duration of ICU stay. In this large cohort, infection was independently associated with an increased risk of hospital death.

/pdf/international-study-of-the-prevalence-and-outcomes-of-26pikgt9mw.pdf

International Study of the Prevalence and Outcomes of Infection in Intensive Care Units

Aims: To evaluate behavioural outcome and quality of life in children aged 8–14 years after neonatal arterial switch operation for transposition of the great arteries. 

Methods: Sixty children operated as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass were evaluated at age 7.9–14.3 years by the Child Behaviour Checklist (CBCL) and the Inventory for the Assessment of the Quality of Life in Children and Adolescents (IQCL). 

Results: Parent reported behavioural outcome on all CBCL problem and competence scores was worse, whereas quality of life on self reported IQCL scores was not reduced compared to the normal population. On multivariate analysis, severe preoperative hypoxia was related to parent reported social problems; peri- and postoperative cardiocirculatory insufficiency was associated with internalising, externalising, attention, and total behavioural problems. Reduced expressive language was associated with total behavioural problems, and poor academic achievement was related to parent reported deficits in school performance. Impaired neurological status and reduced endurance capacity both predicted self reported stress by illness. 

Conclusions: The neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with parent reported long term behavioural impairment, but not with self reported general reduction in quality of life. This discrepancy may be a result of different perception of illness. In our experience, increased risk of long term psychosocial maladjustment after neonatal corrective cardiac surgery is related to the presence of neurological impairment and reduced endurance capacity.

https://adc.bmj.com/content/archdischild/87/6/506.full.pdf

Long term behavioural outcome after neonatal arterial switch operation for transposition of the great arteries

Attentional Dysfunction in Children After Corrective Cardiac Surgery in Infancy

Objective
To evaluate whether the SOFA score can be used to develop a model to predict intensive care unit (ICU) mortality in different countries.

Use of the Sequential Organ Failure Assessment score as a severity score

We have assessed the evidence that closed tracheal suction systems (TSS) prevent ventilator-associated pneumonia (VAP), using a meta-analysis of randomized controlled trials (RCTs). We searched PubMed and Cochrane databases to identify RCTs that compared closed with open TSS for the management of mechanically ventilated (MV) patients. Nine RCTs were included in the meta-analysis. There was no difference in the incidence of VAP between patients managed with closed and open TSS [odds ratio (OR)=0.96, 95% confidence intervals (CI) 0.72–1.28]. There was no heterogeneity among the eligible trials (I2=0, 95% CI 0–0.65). The compared groups did not differ with respect to mortality (OR=1.04, 95% CI 0.78–1.39) or intensive care unit (ICU) length of stay [two RCTs: 12.3 (sd 1.1) vs 11.5 (1.4) days and 15.6 (13.4) vs 19.9 (16.7) days]. Suctioning with closed systems was associated with longer MV duration (weighted mean differences: 0.65 days, 95% CI 0.28–1.03) and higher colonization of the respiratory tract (OR=2.88, 95% CI 1.50–5.52) than open TSS. The available evidence suggests that closed as opposed to open TSS usage did not provide any benefit on VAP incidence, mortality, or ICU stay of MV patients.

Closed tracheal suction systems for prevention of ventilator-associated pneumonia.

The use of the vascular catheters is one of the most important and required interventions in ICUs One of these options is the peripherally inserted central catheter (PICC), which is inserted by habilitated nurses in patients who are in these conditions in the ICU

/pdf/peripherally-inserted-central-catheter-in-critically-ill-1zwvnho9pf.pdf

Peripherally inserted central catheter in critically ill patients

Severe sepsis is one of the major causes of mortality in intensive care units (ICUs) around the world. There are few epidemiological studies based on ACCP/SCCM consensus conference criteria. The incidence of severe sepsis is largely unknown in countries like Brazil.

/pdf/brazilian-sepsis-epidemiological-study-bases-preliminary-35pxl1bn1b.pdf

Brazilian Sepsis Epidemiological Study (BASES): preliminary results from first 439 patients

/pdf/risk-of-factors-for-readmission-in-the-intensive-care-unit-5ce0m8ffgf.pdf

Risk of factors for readmission in the intensive care unit

The great scientific and technological breakthrough in the field of experimental sciences applied to medicine and health sciences is being responsible for the process of dehumanization. To understand the process and bring back a humanistic view to education seems to be necessary to rehumanizing medicine.

/pdf/the-icu-humanization-program-contributions-from-the-1et09ls8mq.pdf

The ICU Humanization Program: contributions from the psychologist team.

In patients with predanirnnt rig -tt ventricular infaretim sinus rhythm is dally important to preserve atrial systole because of adequate rigit ventricular filling. Aitha(i beneficial I rXlyrsuic influence of AV sequential pacing ras rexrtusi in atme previous studies, this method is not being routinely used in the acute infartion settirg. We used AV sequential pacing in 7 patients with acute inferior my dial infarctim and right vattricular involvement. Predarrinant ri.it ventricular failure vias confirmed lr CVP, being equal or g eater than PPP. In all patients ventricular paeirg (70 80/t m) was started on ad<rdssicn because of AV block III*. Cardicenie stork with typical clinical sigis, of ,mia (< 20 ml/h) and lactic acidosis developed in all patients between first and fifth day of hospital stay. Shock vas refractory to volure leading with plasm ex mrrlirg agent (until PPCP 18 mm Ig ras tom), inotropic dry (dopeiin 6 12 n /kg/min and dobitaiin 4 18 mcgfkWmin in all patients, norepirmIrire 0.2 erg/kg/ min in 2 patients), and controlled nmrtmnicai ventilation in 3 patients. After AV sequential pacing (70 80/ruin, AV interval 150 180 ms) was mployed instead of ventricular, va observed sigv.fica t and iimssiiate incrvms^ in cardiacmit mean value 1.9 1/mit e ([arge 1.6 -.2.ü 1/minim to 2.7 1/rein/[ f(range 2.2 3.1 1/min/m ). CVP and P1CP were not sigpificantly altered. In one patient atrial stimulation was not efficient despite the proper position of el ctrc e, acid he died in cirdiogenic shock. Signs of shock disappeared in 6 patients, 5 patients survived and were di.]thargcd. CYO patient dial after the slats rttyths Uns recovered bemuse of sudda i refractory left ventricular failure. We conclude that AV se tial pacing sigraficantiy improves cardiac output in patients with preisuni ant ri t ventricular infarction, AV block III* and cardicgerdc stock. We believe that it sYruld be routinely used in such patients eves before irotropic dnBs.

/pdf/pressure-controlled-ventilation-in-ards-27bqhgosuv.pdf

Pressure controlled ventilation in ARDS

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