Journal of critical care
-
Journal of critical care · Oct 2012
Respiratory syncytial virus morbidity, premorbid factors, seasonality, and implications for prophylaxis.
We investigated factors associated with morbidity and pediatric intensive care unit (PICU) admission in children with respiratory syncytial virus (RSV) infection and explored seasonality and implication of prophylaxis. ⋯ Most infants have mild disease and do not require PICU support. Young infants with history of chronic lung disease, congenital heart disease, and neurodevelopmental conditions appear to be at significantly increased risk for PICU support. There is no winter seasonality for RSV disease in Hong Kong. Therefore, any prophylaxis for at-risk population should provide adequate coverage for the warmer months in subtropical regions.
-
Journal of critical care · Oct 2012
Integrating lung ultrasound in the hemodynamic evaluation of acute circulatory failure (the fluid administration limited by lung sonography protocol).
In circulatory failure, fluid administration limited by lung sonography protocol uses lung ultrasound artifacts and makes sequential diagnosis of obstructive, cardiogenic, hypovolemic, and septic shock. Lung ultrasound is used along with simple cardiac and vena cava analysis. Whenever echocardiography cannot be performed, fluid administration limited by lung sonography protocol is favored because of its simplicity and could prove contributive. ⋯ Whenever noninvasive hemodynamic measures are inconclusive, in a deteriorating patient, a pulmonary artery catheter may be placed. Ultrasound is not a therapy but a guide for treatment, and physicians should aim to treat underlying pathologies. Despite its limitations, general chest ultrasound (lung and cardiac ultrasound) is a powerful diagnostic and monitoring tool reflecting an era of genuine "visual" medicine.
-
Journal of critical care · Oct 2012
Reliability of the validated clinical diagnosis of pneumonia on validated outcomes after intracranial hemorrhage.
Reducing the incidence of hospital-acquired pneumonia (PNU) is important but depends on accurate assessment. We sought to determine the interrater reliability of diagnosis of PNU and its impact on resource utilization and functional outcomes in a high-risk population. ⋯ Pneumonia had poor interrater reliability despite highly trained reviewers and validated criteria. Although the clinical assessment of PNU is difficult, it was associated with greater resource use and worse outcomes. Diagnosis of clinical PNU may be suboptimal for measuring quality of intensive care.
-
Journal of critical care · Oct 2012
Use of wireless motility capsule to determine gastric emptying and small intestinal transit times in critically ill trauma patients.
The purpose of this study is to use a novel wireless motility capsule to compare gastric emptying and small bowel transit times in critically ill trauma patients and healthy volunteers. ⋯ Both gastric emptying and small bowel transit were delayed in critically ill trauma patients.
-
Journal of critical care · Oct 2012
Adrenal insufficiency and response to corticosteroids in hypotensive critically ill children with cancer.
Assessment and treatment of adrenal axis function in critically ill pediatric patients with oncologic disorders have not been well elucidated. Critically ill children with oncologic disorders may be at increased risk for adrenal insufficiency (AI). ⋯ Both RAI and AAI were common in this cohort of critically ill pediatric patients with oncologic disorders. Introduction of steroids was associated with a significant reduction in vasopressors dose.