Intensive care medicine
-
Intensive care medicine · Sep 2018
Multicenter Study Observational StudyFactors associated with health-related quality of life 6 years after ICU discharge in a Finnish paediatric population: a cohort study.
Long-term data are urgently needed in children after intensive care. The aim of this study was to measure health-related quality of life 6 years after intensive care in a paediatric intensive care population. ⋯ The long-term quality of life after paediatric intensive care is good for the majority of children and young people, and it is dependent on the number of chronic diagnoses and the burden of the chronic disease, especially neurological diseases.
-
Intensive care medicine · Sep 2018
Multicenter Study Observational StudyIntensive care utilization following major noncardiac surgical procedures in Ontario, Canada: a population-based study.
Patients are sometimes admitted to intensive care units (ICU) after elective noncardiac surgery for advanced monitoring and treatments not available on a general postsurgical ward. However, patterns of ICU utilization are poorly understood. Our aims were to assess the incidence and determinants of ICU utilization after elective noncardiac surgical procedures. ⋯ There is a wide variation in early ICU admission across and within surgical procedures. The individual hospital accounts for a large proportion of this variation. Further research is required to identify the basis for this variation and to develop better methods for allocating ICU resources for postoperative management of surgical patients.
-
Intensive care medicine · Sep 2018
ReviewTime-limited trial of intensive care treatment: an overview of current literature.
In critically ill patients, it is frequently challenging to identify who will benefit from admission to the intensive care unit and life-sustaining interventions when the chances of a meaningful outcome are unclear. In addition, the acute illness not only affects the patients but also family members or surrogates who often are overwhelmed and unable to make thoughtful decisions. ⋯ In this article, we discuss current research on different aspects of TLTs in the intensive care unit. We propose how and when to use TLTs, discuss how much time should be taken for a TLT, give an overview of the potential impact of TLTs on healthcare resources, describe ethical challenges concerning TLTs, and discuss how to evaluate a TLT.
-
Intensive care medicine · Sep 2018
Multicenter StudyPrevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a retrospective nationwide study.
Thrombocytopenia is a frequent and serious adverse event in patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock. Similarly to postcardiac surgery patients, heparin-induced thrombocytopenia (HIT) could represent the causative underlying mechanism. However, the epidemiology as well as related mortality regarding HIT and VA-ECMO remains largely unknown. We aimed to define the prevalence and associated 90-day mortality of HIT diagnosed under VA-ECMO. ⋯ Prevalence of HIT among patients under VA-ECMO is extremely low at 0.36% with an associated mortality rate of 33.3%, which appears to be in the same range as that observed in patients treated with VA-ECMO without HIT. In addition, HIT was ultimately ruled out in one-third of patients with clinical suspicion of HIT and positive anti-PF4/heparin antibodies.
-
Intensive care medicine · Sep 2018
Improved short- and long-term outcome of allogeneic stem cell recipients admitted to the intensive care unit: a retrospective longitudinal analysis of 942 patients.
Intensive care unit (ICU) admission of allogeneic hematopoietic stem cell transplant (HSCT) recipients is associated with relatively poor outcome. Since longitudinal data on this topic remains scarce, we analyzed reasons for ICU admission as well as short- and long-term outcome of critically ill HSCT recipients. ⋯ Besides ARF and septic shock, cardiac events were especially a major reason for ICU admission. Both short- and long-term survival of critically ill HSCT patients has improved significantly in recent years, and survival of HSCT recipients discharged from hospital is not significantly affected by a former ICU stay.