Journal of critical care
-
Journal of critical care · Oct 2011
Multicenter Study Comparative StudyEvaluation of standard and modified severity of illness scores in the obstetric patient.
To test discrimination and calibration of APACHE-II and SAPS-II risk prediction scores in a cohort of obstetric patients, and to evaluate the effect of modifying these scores for the physiological changes in pregnancy. ⋯ APACHE-II and SAPS-II are good discriminators of illness severity and may be valuable for comparing obstetric cohorts, but APACHE-II significantly over-estimates mortality.
-
Journal of critical care · Oct 2011
Clinical TrialReduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program.
Healthcare-associated infections (HCAIs) impact 10% of hospitalized patients. Some of these infections result from bacterial cross contamination and poor compliance with guidelines (Pittet D: Compliance with hand disinfection and its impact on hospital-acquired infections. J HospInfect 48 Suppl A:S40-S46, 2001); (Watanakunakorn C, Wang C, Hazy J: An observational study of hand washing and infection control practices by healthcare workers. Infect Control Hosp Epidemiol 19:858-860, 1998). Contamination of provider hands may be a modifiable risk factor. We instituted a novel multimodal system designed to improve hand hygiene by ICU providers. ⋯ A novel multi-modal hand hygiene system resulted in a reduction in VAP. Provider hand contamination during patient care in the ICU is a modifiable risk factor for reducing ventilator associated pneumonias.
-
Journal of critical care · Oct 2011
Comparative StudyBloodstream infection after elective liver transplantation is associated with increased mortality in patients with cirrhosis.
This study aims to investigate what factors predict the development of postoperative bloodstream infection (BSI) in patients transplanted electively for chronic liver disease and compare outcomes in infected transplant recipients (BCLD) with noninfected patients (CLD). ⋯ Bloodstream infection post-LT was associated with increased severity of illness on admission, greater requirements for organ support, and increased mortality.
-
Journal of critical care · Oct 2011
A multidrug-resistant Acinetobacter baumannii outbreak in intensive care unit: antimicrobial and organizational strategies.
Multidrug-resistant Acinetobacter baumannii (MRAB) is an emerging cause of intensive care unit (ICU) outbreaks. Patients are the main reservoirs, inducing cross transmission. We describe an MRAB outbreak that occurred in the Prato Hospital ICU in June to August 2009. ⋯ Enhanced infection control measures and adequate antibiotic strategy limited the outbreak. Tigecycline allowed rapid recovery. Nevertheless, resistance ensued; so colistin remained the only therapeutic option. However, pan-drug resistance has been reported.
-
Journal of critical care · Oct 2011
Serum β-d-glucan of critically ill patients with suspected ventilator-associated pneumonia: preliminary observations.
The purpose of this pilot study was to determine whether β-d-glucan (BG) was associated with Candida in the lung and risk of death in patients with suspected ventilator-associated pneumonia (VAP). ⋯ β-d-Glucan positivity in patients with a suspected VAP may be a marker for Candida in the lung and worse outcomes. Further validation of this postulate is warranted.