Critical care medicine
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Critical care medicine · Jun 2015
The Volume-Outcome Relationship in Critically Ill Patients in Relation to the ICU-to-Hospital Bed Ratio.
A volume-outcome relationship in ICU patients has been suggested in recent studies. However, it is unclear whether the ICU-to-hospital bed ratio affects the volume-outcome relationship. The aim of this study is to investigate the relationship between hospital volume and in-hospital mortality of adult ICU patients in relation to the ratio of ICU beds to regular hospital beds. ⋯ An inverse relationship between hospital volume of ICU patients and mortality was seen only when the ICU-to-hospital bed ratio was sufficiently high. Regionalization and increasing the number of ICU beds in referral centers may improve patient outcomes.
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Critical care medicine · Jun 2015
Lessons Learned: Critical Care Management of Patients With Ebola in the United States.
This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center. ⋯ Safe and effective care of patients with Ebola virus disease requires significant communication and planning. Adherence to a predetermined isolation protocol is essential, including proper donning and doffing of personal protective equipment. Location of the patient care area and the logistics of laboratory testing, diagnostic imaging, and the removal of waste must be considered. Patients with Ebola virus disease are often dehydrated and need adequate vascular access for fluid resuscitation, nutrition, and phlebotomy for laboratory sampling. Advanced planning for acute life-threatening events and code status must be considered. Intensivist scheduling should account for the significant amount of time required for the care of patients with Ebola virus disease. With appropriate precautions and resources, designated hospitals in the United States can safely provide care for patients with Ebola virus disease.
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Critical care medicine · Jun 2015
Intraosseous Versus Central Venous Catheter Utilization and Performance During Inpatient Medical Emergencies.
Intraosseous access is a rapid and effective route of fluid and drug administration. Its use has been proven in emergency medicine, pediatrics, and the military. We aimed to assess its performance and utilization against landmark-guided central venous catheter placement during inpatient medical emergencies. ⋯ It is feasible to incorporate intraosseous use during medical emergency team calls. Intraosseous had significantly higher first-pass success rates and faster placement compared with central venous catheters. Intraosseous operators reported high satisfaction and confidence in its use. Prospective randomized studies comparing intraosseous and central venous catheter are warranted.
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Critical care medicine · Jun 2015
Toll-Like Receptor 9 Signaling Regulates Tissue Factor and Tissue Factor Pathway Inhibitor Expression in Human Endothelial Cells and Coagulation in Mice.
Bacterial DNA (CpG DNA) persists in tissues and blood under pathological conditions that are associated with enhanced intravascular coagulation. Toll-like receptor 9 recognizes CpG DNA and elicits innate and adoptive immunity, yet the impact of CpG DNA on coagulation has not been studied. In this study, we investigated the effects of CpG DNA on the expression and activity of tissue factor, a key initiator of coagulation and tissue factor pathway inhibitor in human coronary artery endothelial cells and on coagulation in mice. ⋯ Our findings demonstrate that bacterial DNA through Toll-like receptor 9 shifted the balance of tissue factor and tissue factor pathway inhibitor toward procoagulant phenotype in human coronary artery endothelial cells and activated blood coagulation in mice. Our study identifies Toll-like receptor 9 inhibitory oligonucleotides as potential therapeutic agents for the prevention of coagulation in pathologies where bacterial DNA may abundantly be present.
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Critical care medicine · Jun 2015
Treatment of Highly Virulent Extraintestinal Pathogenic Escherichia coli Pneumonia With Bacteriophages.
To study the effect of bacteriophage treatment on highly virulent extraintestinal Escherichia coli pneumonia in mice and compare it with conventional antimicrobial treatment. ⋯ Bacteriophage treatment was as effective as antibiotherapy to provide 100% survival rate in a lethal model of highly virulent E. coli pneumonia. Adaptation of a bacteriophage is a rapid solution to improve its efficacy toward specific strains. These results suggest that phage therapy could be a promising therapeutic strategy for ventilator-associated pneumonia.