ICU Research Papers - Academia.edu (original) (raw)

Introduction: Occupational stress is inevitable, but prolonged and intense can lead to serious health problems. Neglecting this significant aspect of work and inadequate treatment of the first indicators leads to the reduced working capacity of health-care professionals.
Methods: Assessing the working conditions of 100 health-care professionals regarding stress impact on empathy and workability was the primary goal of this study. A survey was conducted to identify differences between work in intensive care units and other clinical departments all related to empathy, workability, and stress perceiving to determine what is a better predictor of workability.
Results: In the research group, “intensive care units” significantly lower empathy quotients, poorer workability, and different stressors were registered compared to research group named “other departments.”
Conclusion: The main conclusion of the study states different dynamics in the working environment of intensive care units compared to other departments that could potentially harm the personal capacity of health-care professionals.

- by and +2
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- Stress, Empathy, Stress and Burnout, ICU

To assess the opinion of intensive care unit (ICU) personnel and the impact of their personality and religious beliefs on decisions to forego life-sustaining treatments (DFLSTs). Cross-sectional, observational, national study in 18 multidisciplinary Greek ICUs, with >6 beds, between June and December 2015. 149 doctors and 320 nurses who voluntarily and anonymously answered the End-of-Life (EoL) attitudes, Personality (EPQ) and Religion (SpREUK) questionnaires. Multivariate analysis was used to detect the impact of personality and religious beliefs on the DFLSTs. The participation rate was 65.7%. Significant differences in DFLSTs between doctors and nurses were identified. 71.4% of doctors and 59.8% of nurses stated that the family was not properly informed about DFLST and the main reason was the family's inability to understand medical details. 51% of doctors expressed fear of litigation and 47% of them declared that this concern influenced the information given to family and...

- by Vasilios Koulouras
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- Religion, Decision Making, Personality, Family

Background: Anaesthetic record is an essential part of the patient's medical record. It includes the perioperative management that is relevant to the anaesthesia practice. This information helps other staff who will be involved in the care of the patient, for medico-legal defense and for quality assurance. We sometimes found anaesthetic recording sheets with incomplete information during the postoperative visit of patients in the recovery room and on the wards in our hospital. We aimed to assess the level of anaesthetic record completeness.

- by Endale Gebremedhn
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- Health Sciences, Affective Neuroscience, Medicine, ICU
- by Carlos Darcy A Bersot, MD, TEA, MSc INPR, TSA/SBA.
- •
- Anesthesiology, ICU
- by Muhammad Rodli
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- ICU

Ciągła terapia nerkozastępcza jest często stosowanym leczeniem na oddziałach intensywnej terapii, które wymaga kompleksowej wiedzy oraz kompetencji personelu. Celem pracy jest przedstawienie problemów związanych z klinicznym zastosowaniem metod ciągłej terapii nerkozastępczej w ostrej niewydolności nerek. Coraz łatwiejszy i szerszy dostęp wielu ośrodków klinicznych do tych metod przy jednoczesnym minimalizowaniu kosztów oraz problemów technicznych uzasadniają konieczność ustalenia wytycznych, dotyczących czasu
i sposobu ich wdrażania w ostrej niewydolności nerek. W dostępnym piśmiennictwie wciąż brakuje wieloośrodkowych badań z randomizacją, porównujących różne metody leczenia ostrej niewydolności nerek. Stąd decyzja o wyborze sposobu terapii opiera się na doświadczeniu i praktyce klinicznej poszczególnych zespołów terapeutycznych.

- by Dominika Gniewek
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- Nursing, Nurse Education, Public Health, ICU
- by Lupita Sari
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- Nursing, ICU, Referate, Makalah Bahasa Indonesia

A. DEFINISI ICU ICU adalah ruang rawat di Rumah Sakit yang dilengkapi dengan staf dan peralatan khusus untuk merawat dan mengobati pasien yang terancam jiwa oleh kegagalan / disfungsi satu organ atau ganda akibat penyakit, bencana atau komplikasi yang masih ada harapan hidupnya (reversible). Dalam mengelola pasien ICU, diperlukan dokter ICU yang memahami teknologi kedokteran, fisiologi, farmakologi dan kedokteran konvensional dengan kolaborasi erat bersama perawat terdidik dan terlatih untuk critical care. Pasien yang semula dirawat karena masalah bedah/trauma dapat berubah menjadi problem medik dan sebaliknya. B. SEJARAH ICU ICU mulai muncul dari ruang pulih sadar paska bedah pada tahun 1950. ICU modern berkembang dengan mencakup penanganan respirasi dan jantung menunjang ffal organ dan penanganan jantung koroner mulai tahun 1960. Pada tahun 1970, perhatian terhadap ICU di Indonesia semakin besar (ICU pertama kali adalah RSCM Jakarta), terutama dengan adanya penelitian tentang proses patofisiologi, hasil pengobatan pasien kritis dan program pelatihan ICU.Dalam beberapa tahun terakhir, ICU mulai menjadi spesialis tersendiri, baik untuk dokter maupun perawatnya. C. LEVEL ICU 1. Level I (di Rumah Sakit Daerah dengan tipe C dan D) Pada Rumah Sakit di daerah yang kecil, ICU lebih tepat disebut sebagai unit ketergantungan tinggi (High Dependency). Di ICU level I ini dilakukan observasi perawatan ketat dengan monitor EKG. Resusitasi segera dapat dikerjakan, tetapi ventilator hanya diberikan kurang dari 24 jam. 2. Level II ICU level II mampu melakukan ventilasi jangka lama, punya dokter residen yang selalu siap di tempat dan mempunyai hubungan dengan fasilitas fisioterapi, patologi dan radiologi.

- by Asma'ul Khusna
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- ICU, Keperawatan, ILMU KEPERAWATAN

The complete evacuation of hospital facilities is always difficult and complicated process. It has always been considered a last resort during any kind of threat. The patients in Intensive Care Units (ICUs) make this scenario more challenging. After the crisis of hurricane Katrina in 2005, the ICU patients’ evacuation has become a considerable issue that need to address. The increasing number of man-made and natural disasters has generated a considerable interest in hospital evacuation issues, but very few studies have addressed this problem. The purpose of this study is to develop design considerations for hospital facilities to support ICU patients’ complete evacuation and transportation during any kind of disaster. The following three objectives are considered for fulfilling the requirement of this study: (a) to identify the disaster threats for hospital building that drive the need for complete evacuation, (b) to understand the evacuation methods, and (c) to develop the design considerations based on the threats’ pattern, case-studies and experts’ reviews. To achieve the desired objectives, the study has considered the qualitative research method designed with Case-Based Reasoning. The study design has three phases; a) analysis of threats and evacuation methods from literature review, b) case study analysis to develop design recommendations from literature review and interview with hospital administrators, and c) collect the experts’ views and suggestions on design recommendations.
The study has developed a matrix on ICU patients’ evacuation methods according to the different kinds of disaster threats. The study is only focused on design considerations of some specific parameters for hospital building evacuation design. This study provides a comprehensive assessment of best suited design strategies. This study is a supportive resource for healthcare architects, planners, researchers, administrators and emergency management organizations to develop evacuation guidelines for the hospital ICU patients.

The EVICURES project developed a new user-friendly design model for intensive and intermediate care facilities. In this model staff, management, patients and their families, and corporate, hospital district and other cooperation partners jointly participated in the design work from day one. EVICURES is the fi rst project to study evidence-based design (EBD) activities in Finland. It draws on research information on EBD, users' views, and an extensive multidisciplinary network. In addition, the design of operations seeked to improve the quality and effectiveness of intensive care and increase patient and staff satisfaction.

- by Tapio Hellman and +7
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- Acoustics, Nursing, Architecture, Virtual Reality (Computer Graphics)
- by Lucien van der Walt
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- Anarchism, Class, Colonialism, Communism

Patients in intensive space have the right to get special attention due to metabolic changes that have an impact on nutritional status. Critical patients will experience an increase in metabolism as the body's response to disease. Assessment of nutritional status must be carried out routinely in the hospital, including in the ICU. The Council of Europe 2001, that there are no nutritional assessment standards that can be used for all patients treated. The assessment must be early, simple, based on current science and can be adapted in the clinical environment. The American Society of Parenteral and Enteral (ASPEN) recommends assessing nutritional status or nutritional screening tools in patients treated by using Subjective Global Assessment (SGA). Another measure of nutritional status assessment that can be used is the Malnutrition Screening Tools (MST). MST is a nutritional status assessment tool that has been used by the General Intensive Care Unit (ICU) in Achmad Mochtar Bukittinggi Hospital. This study aims to analyze the differences in the accuracy of MST and SGA in assessing nutritional status as well as differences in sensitivity of MST and SGA as indicators of the incidence of pressure sores in patients in the ICU of the Achmad Mochtar Bukittinggi Hospital. The type of this research is this research is quantitative research with comparative hypothesis type and cross-sectional research design. The results of this study indicate that SGA is more accurate in assessing nutritional status in patients in intensive rooms.

- by Jurnal Kesehatan
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- Nutrition, Malnutrition, ICU, Bukittinggi

Clinical evaluation of pupils is considered as an essential part of neurological examination. The pu-pillary response to light is controlled by the autonomic nervous system. Numerous factors affect pupils dynamics, like e.g. luminance, visual field area, pain, drug administration, age, the functional integrity of anatomical structures involved, e.t.c. Moreover, pupillometry card method and examina-tion of pupil reaction with the use of a penlight is subjective to a lot of bias. Portable infrared pupil-lometry allows a more objective and detail evaluation of pupil’s dynamics. That’s why it has al-ready found applications in various clinical areas, like e.g. neurology, psychology, ophthalmology, endocrinology, anesthesia, pain management, intensive care, emergency medicine. This review fo-cuses on physiology of pupil’s dynamics and on applications of infrared pupillometry in periopera-tive setting

- by Theodoros Aslanidis
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- Neuroscience, Pupillometry, ICU, Glasgow Coma Scale

The coronavirus disease (COVID-19) is a severe, ongoing, novel pandemic that emerged in Wuhan, China, in December 2019. As of January 21, 2021, the virus had infected approximately 100 million people, causing over 2 million deaths. This article analyzed several time series forecasting methods to predict the spread of COVID-19 during the pandemic’s second wave in Italy (the period after October 13, 2020). The autoregressive moving average (ARIMA) model, innovations state space models for exponential smoothing (ETS), the neural network autoregression (NNAR) model, the trigonometric exponential smoothing state space model with Box–Cox transformation, ARMA errors, and trend and seasonal components (TBATS), and all of their feasible hybrid combinations were employed to forecast the number of patients hospitalized with mild symptoms and the number of patients hospitalized in the intensive care units (ICU). The data for the period February 21, 2020–October 13, 2020 were extracted from the website of the Italian Ministry of Health (www.salute.gov.it). The results showed that (i) hybrid models were better at capturing the linear, nonlinear, and seasonal pandemic patterns, significantly outperforming the respective single models for both time series, and (ii) the numbers of COVID-19-related hospitalizations of patients with mild symptoms and in the ICU were projected to increase rapidly from October 2020 to mid-November 2020. According to the estimations, the necessary ordinary and intensive care beds were expected to double in 10 days and to triple in approximately 20 days. These predictions were consistent with the observed trend, demonstrating that hybrid models may facilitate public health authorities’ decision-making, especially in the short-term.

- by Gaetano Perone
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- Health, Artificial Neural Networks, ICU, Forecasting for Arima Model

Background: Acute Kidney Injury (AKI) is an abrupt decrease in kidney function, leading to the retention of urea and other nitrogenous waste products. Poisoned patients admitted to the Intensive Care Unit (ICU) may develop AKI due to some reasons. This study was done to evaluate the AKI in poisoned patients admitted to ICU. Methods: 146 patients, admitted to the ICU of Imam Reza Hospital from March 2017 to March 2018 were studied. AKI status was assessed using Acute Kidney Injury Network (AKIN) and Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE) classification. Data analysis was done through SPSS V. 22 software. Results: Opioids, organophosphates, aluminum phosphide, multiple drugs, and other types of poisoning were the main five poisoning classes. Opioid toxicity was had the highest frequency with 51 patients; cases in this group experienced longer length of hospitalization stay and higher serum creatinine level than others did. Among 146 patients, 19 patients (12.8%) died, and 97 patients (66%) were transferred to the ICU. Of all cases, 18 patients (12.3%) had renal dysfunction (six patients were at risk, five patient at injury, and seven patients were at failure phase based on the RIFLE criteria). Renal replacement therapy was required in 24 cases (16.4%). Conclusion: It is unlikely to detect a significant difference in the occurrence of AKI between the main poisoning classes. Being the largest group of intoxicated patients admitted to the ICU, the opioid poisoning had the highest rate of AKI

- by Catherine Clarissa
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- Rehabilitation, Critical Care, ICU, Critical Care Nursing

Objective: Critically ill patients require high-intensity care and may be at especially high risk of iatrogenic injury
because they are severely ill. We sought to study the incidence and nature of adverse events and serious errors in
the critical care setting.
Design: We conducted a prospective 12 month observational study. Incidents were collected with use of a
multifaceted approach including direct continuous observation. The physicians independently assessed incident
type, severity, its preventability as well as systems-related failures.
Measurements and main results: The primary outcomes of interest were the incidence and rates of adverse
events and serious errors per 1000 patient-days. A total of 242 patients were studied during 1190 patient-days. We
found 60 adverse, including 33 (55%) non preventable and 27 (45%) preventable adverse events as well as 114
serious errors. The rates per 1000 patient-days for all adverse events, preventable adverse events, and serious
errors were 80.5, 36.2, and 149.7, respectively. Among adverse events, 13% (8/60) were life-threatening or fatal;
and among serious errors, 10% (12/114) were potentially life-threatening. Among all the errors whether adverse or
serious errors, medication errors were the commonest (37.93%; 66/174).
Conclusions: Adverse events and serious errors involving critically ill patients were common and often
potentially life-threatening. Although many types of errors were identified, failure to carry out intended treatment
correctly was the leading category.

- by Anesthesia & Clinical Research
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- Anesthesiology, ICU, INTENSIVE CARE, Adverse Events

Objective: to identify ergonomic risks to which nurses working in critical hospital units are exposed and possible risk factors associated with them. Method: this is a qualitative, exploratory-descriptive study. The study sample constituted of 27 nurses who worked in critical units of a public university hospital. After the
data were obtained, they were analyzed and structured according to semantic similarities. The study project
was approved by the Research Ethics Committee, Protocol 5532/12. Results: three categories emerged in the
developement of this research: Ergonomic risks to which critical unit nurses are exposed; Work environment
and development of ergonomic risk factors; Nurse´s exposure time to ergonomic risk factors. Conclusion: we
found the presence of ergonomic risks in these units. Several factors predispose to these risks, including physical exertion, inadequate posture, manual lifting and transport of weight, long working hours and repeatability

- by Álvaro Sousa
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- Health Sciences, Ergonomics, Public Health, Health Care Management
- by Quanghien Nguyenviet
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- ICU
- by Jaber S. Alqahtani and +1
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- Respiratory Medicine, Critical Care, Respiratory therapy, ICU

Since the first detection of a cluster of COVID-19 patients in China in late 2019, it becomes a global concern due to its transmissibility and ability to progress patients in severe respiratory failure and acute respiratory distress syndrome, which need intensive care unit support for a long time. We observed the repurposing use of remdesivir and favipiravir whether considered as a therapeutic option or not through survival rate and changes in biomarker during 10-day treatment stay in ICU. Original Research Article Nasir et al.; JPRI, 32(45): 14-22, 2020; Article no.JPRI.64130 15 The retrospective observational study in a tertiary care hospital dedicated to COVID-19 at Dhaka, Bangladesh was done at the peak of COVID-19 pandemic in Bangladesh. The mortality rate, length of ICU stays and eight prognostic biomarkers of patients treated with remdesivir and favipiravir was observed as one of the first ever reported experience in Bangladesh. Among the critically ill patients in ICU, 26 (44.8%) died and 32 (55.2%) were cured during the study period and highest mean duration of stay in ICU was observed (14.33 days and 18.13 days) in FPV-treated patients. Mean of means for all biomarkers CRP (26.0) and d-Dimer (2.64) was recorded higher in favipiravir treated patients in death cases, but NLR, d-NLR, platelet, PLR was much higher in remdesivir treated patient of both death and improved cases. Though overall outcome variables between death and improved cases were not statistically significant (p<0.39) The severity of disease progression in critically ill COVID-19 patients in ICU depends on comorbidities and hyper-responsive inflammatory or immunological biomarkers to predict. Though the emergency use authorization and repurposing use of different antivirals are still on trial, but remdesivir and favipiravir revealed not much hope in improving prognostic biomarkers, survival rate and disease progression at the peak of pandemic in Bangladesh.

- by Morshed Nasir
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- Biomarkers, ICU, Antiviral, COVID-19 PANDEMIC

Intensivists and respirologists are very likely to encounter patients with OHS and AHRF. A high index of suspicion is needed to avoid misdiagnosis and delayed treatment that can only worsen morbidity and mortality and increase healthcare costs. Despite a lack of relevant RCTS, there is now a consensus that NIV is the first-line treatment for OHS presenting with acute-on-chronic hypercapnic respiratory failure. In this setting, NIV improves alveolar ventilation, hypercapnia, and hypoxemia, avoids invasive ventilation, and probably decreases the frequency of adverse outcomes.

- by Ahmed S BaHammam
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- Obesity, Critical Care, COPD, Hypertension
- by Pekka Tuomaala
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- Computer Science, Acoustics, Nursing, Architecture

, 35,40 on behalf of the RAPID trial investigators ABSTRACT OBJECTIVE To evaluate the effects of therapeutic heparin compared with prophylactic heparin among moderately ill patients with covid-19 admitted to hospital wards. DESIGN... more

- by Ahmed S BaHammam
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- Hemostasis and Thrombosis, Mortality, Heparin, ICU

Objective: To compare short-term complications in elective and emergency tracheostomy.
Study Design: Comparative cross sectional.
Materials and Methods: In this study 60 patients undergoing tracheostomy were included. Patients were divided into two groups, each with 30 participants. Patients in group A had elective whereas group B had emergency tracheostomy. Short term complications including hemorrhage, surgical emphysema, cardiac arrest and stomal infection were noted in both groups. Chi-square test was applied as test of significance to compare the two groups.
Results: Emergency tracheostomy is associated with significantly increased risk of hemorrhage and surgical emphysema (p value being <0.05. There was no statistical difference in occurrence of stomal infection and cardiac arrest between the two groups.
Conclusion: Tracheostomy performed in emergency is fraught with complications. Our study validates the fact that emergency tracheostomy is associated with significantly increased risk of postoperative hemorrhage and surgical emphysema.

- by Tarique A H M E D Maka
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- ICU, ENT and Head and Neck Surgery, Otorhinolaryngology, Tracheostomy

It is of utmost importance to protect our healthcare professionals, who are the most important resources for any country today. The commitment behind this article and proposal is to ensure that we do not lose even one more doctor or nurse to COVID-19. In the opinion of the authors, the current design of most of the ICUs, where the air is recirculated through the air-conditioning, is not suited for treating the highly infectious patients of COVID-19, and may be one of the causes of the thousands of infections among the healthcare workers, which has also led to the death of more than two thousands of them around the world. One is not sure whether this is the reason behind the unusual death rate of patients put on ventilators too. This article proposes a cost-effective redesign of the existing ICUs and suggestions for choosing the buildings intended to be converted to makeshift hospitals to take care of the patients infected by the corona virus. Also, where the personal protective equi...

- by Kanishq Sharma
- •
- Safety Engineering, Design, Occupational Health & Safety, Stress

Background: Cardiac Surgery dept. is a new unit of Joint Corps Armed Forces since March 2013. In order to support the project of organization and opening of a direct admission CS-ICU supported by minimum but well trained staff nurses we... more

- by Charalampos T Martinos and +3
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- Cardiac Surgery, ICU

مكان حساس و مستعدي براي بروز و گسترش مقاومت آنت يبيوتيكي است. پنوموني ، (ICU) سابقه و هدف: بخش مراقب تهاي ويژه ها م يباشد و ممكن است تا 70 % نيز مرگ و مير داشته باشد. هدف از مطالع هي حاضر ICU شايعترين عفونت اكتسابي بيمارستاني در بيمارستان يحي ينژاد ICU شناسايي الگوي حساسيت آنت يبيوتيكي باكتر يهاي گرم منفي جدا شده از كشت ترشحات تنفسي بيماران م يباشد. بستري بودند، به فواصل زماني ICU روش كار: در اين مطالعه توصيفي و مقطعي از تمامي بيماراني كه به مدت بيش از 3 روز در منظم 5 روزه نمون هگيري انجام شد. در نهايت از 91 بيمار مجموعاً 300 مورد كشت بدست آمد و الگوي حساسيت آنتي بيوتيكي ميكرو ارگانيس مهاي جدا شده از آنها تعيين گرديد. 43 %) و سودوموناس آئروژينوزا ( 8%) به ترتيب شايعترين باكتر يهاي گرم منفي بودند كه در محي طهاي كشت / يافته ها: انتروباكتر ( 3 رشد نمودند. باسي لهاي گرم منفي به ايمن يپنم بيش از ساير آنتي بيوتي كها حساسيت داشتند و در 8 مورد ميكرو ارگانيس مهاي گرم منفي حاصل به تمام انواع آنتي بوتي كها مقاوم بودند. بخشهاي مرافبتهاي ويژه بهتر است شايعترين باكتر يها و الگوي حساسيت آنتي بيوتي...

- by Alireza Baratloo
- •
- Respiratory Medicine, ICU, Bacillus, Gram-negative bacteria

Prolonged stay in the Intensive Care Unit (ICU) is associated with impaired physical function, low quality of life and increased Rationale: cost of care. Current evidences suggest that early mobilization (EM) in the ICU is safe, feasible and results in physiological and functional improvement in critically ill patients. Despite its benefits, EM in the ICU is not a common practice. Factors relating to healthcare provider, such as level of knowledge, attitude and practices may contribute to this trend. As a first step towards adopting routine EM in our ICU, we investigated the current level of knowledge, attitude and practices of care professional about EM. We conducted a cross-sectional survey of level of knowledge, attitude and practices of physicians, physiotherapists and nurses Methods: working in our ICU – a tertiary healthcare institution. A 20-item questionnaire, which was adapted from previous studies and pretested during a pilot, was used to collect information on variables of interest. Informed consent was obtained from participants prior to the study. Extended chi square testing was performed to check for significant differences in response across professions. A total of 56 health care providers comprising of 24 (43%) physicians, 22 (39%) physiotherapist and 10 (18%) nurses participated Results: in the study. Most (89%) clinician indicated knowledge about benefits of EM, but only 30% showed adequate knowledge about what constitute EM. 5% of the participants had knowledge about EM guidelines. 45 (80%) reported that the risk associated with early mobilization of patients on mechanical ventilator outweighs its benefits. While 75% of the respondents indicated they will not ambulate patient on MV or on vasopressor agents, 65% agreed that critically ill patient could be mobilized in the ICU. Most (83%) of the participants did not train or work at an institution where patients are actively mobilized in the ICU and consequently feel they are not competent to implement EM. More physiotherapist indicated willingness to ambulate patient on MV, while more physicians reported unwillingness to ambulate patients on vasopressor agents (p<0.05). Although health care providers at our ICU are knowledgeable about benefits of EM, most perceive the risks associated with Conclusion: EM outweigh its benefits and most showed reluctance to EM in ICU.

- by Ayodele Akinremi
- •
- Rehabilitation, ICU, early mobilization in ICU patients, Barriers to rehab
- by Mostafa El-Hodhod
- •
- Pulmonology, Pediatric Gastroenterology, ICU

It is of utmost importance to protect our health-care professionals, who are the most important resources for any country today. The commitment behind this article and proposal is to ensure that we do not lose even one more doctor or nurse to COVID-19. In the opinion of the authors, the current design of most of the ICUs, where the air is recirculated through the airconditioning , is not suited for treating the highly infectious patients of COVID-19, and may be one of the causes of the thousands of infections among the healthcare workers, which has also led to the death of more than a thousand of them around the world. One is not sure whether this is the reason behind the unusual death rate of patients put on ventilators too. This article proposes a cost-effective redesign of the existing ICUs and suggestions for choosing the buildings intended to be converted to makeshift hospitals to take care of the patients infected by the corona virus. Also, where the personal protective equipm...

- by Kanishq Sharma
- •
- Safety Engineering, Design, Occupational Health & Safety, Stress

Studies indicate alarmingly high number of death, by medical errors, especially in the US 23. This review article aims to use studies around the world in order to examine the role clinical pharmacists can play, as proactive health team members in an Intensive Care Unit (ICU), in preventing health risks, particularly those ending in life losses. It also examines clinical pharmacist interventionist role by focusing on optimizing the quality of pharmacotherapy and patient safety. The goal of creating an advanced medical treatment integrated team is already a trend in western countries and pharmacist roles in clinical decisions is expanding, in a very specialized fashion. This therefore although puts pharmacists under a greater burden of responsibility than ever before, but it is well justified, since it prevents a considerable number of health risks, by achieving a relevant reduction in mortality rates, and at the same time cuts down unnecessary expenses. According to ASHP Guidelines 20 : " pharmacist should function as a liaison between pharmacy and other clinical staff in different departments such as anesthesiology, surgery and antibiotic use. " The paper examines the role of the clinical pharmacists as experts of excellence in drug use and its impact in ICU that will eventually reflect in not only reducing mortality rates and improving clinical outcomes but also lowering considerably the costs of drugs, medical devices, consequential costs caused by medical errors, number of recovery days in the hospital and more. This can be obtained by using clinical pharmacist to guard, oversee, both adjust/correct therapies and take a task of using a management tool, in every day ICU's activities. Based on biomedical literature, we can observe a general improvement in different clinical outcomes and as a result a noticeable reduction in mortality rates, when a clinical pharmacist is a permanent member of the medical team. In brief words, we are here to help not only in increasing life quality of the patients in need of a functional healthcare system, but also in removing unnecessary cost burdens, which eventually prevents economy turmoil.

- by luisetto mauro and +1
- •
- ICU

Adequate adrenocortical function is essential to survive critical illness. The goal of this study was to determine whether eosinophilia could serve as a useful and early marker of adrenal insufficiency in critically ill patients with severe septic shock. During a 1-year period, we prospectively studied 294 ICU patients.16 patients (5.4% of ICU admissions) with eosinophilia more than 3% of the white blood cell count and septic shock unresponsive to adequate fluid and vasopressor therapy, were included. A high dose (250 mcg i.v) corticotropin stimulation test was performed. Eosinophilia (>3%)

- by Theodoros Aslanidis
- •
- Eosinophil, Critical Care, Critical Care Medicine, ICU

This literature review is an attempt to gain more insight to the recent studies about permissive hypotension as an alternative to the current adult trauma protocols. It will try answer whether permissive hypotension is beneficial or not to a bleeding trauma patient based on available literature and clinical and laboratory research. It will also attempt to discuss its limitations in the clinical setting. As such, it contains the review of several current and seminal studies on permissive hypotension strategies in managing bleeding adult trauma patients

- by Andy Rimando
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- ICU, Anesthesia, Nurse anesthesia, Permissive Hypotension
- by Ahmet E Erbaycu
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- ICU, Tracheostomy, Intubation

Background/Aims: One of the first steps in developing quality improvement programs for hospitals and reducing patients’ waiting time is to understand the customer’s expectations and then aligning the health care services with those... more

- by HealthMED Journal
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- ICU, CCU, Hospital, Waiting Line

Strokes are a syndrome of rapidly developing clinical symptoms and signs of focal (or at times global) disturbance of cerebral function enduring more than 24 hours (unless interrupted by surgery or death), with no apparent cause other than of vascular origin. The majority are ischemic, secondary to arterial occlusion by in-situ thrombus or embolus, with the remainder being due to intracerebral haemorrhage or subarachnoid haemorrhage. The electro cardiac irregularities subsequent acute stroke are common and seen in both ischemic and hemorrhagic stroke. This research aims to find the relation of the Electrocardiogram (ECG) changes in patients with acute stroke and its pattern. A cross-sectional study conducted in the emergency department of Baghdad teaching hospital in Baghdad City/Iraq. Purposing sampling adopted, and the sample size were=100 patients. The central part of the sample was male 64. About half of them were 55–64 years old. Various ECG changes observed in the present study including rhythm disturbances (like S-T Depression, T Wave Inversion, Q-T Prolongation, Sinus Tachycardia, Sinus Bradycardia, U Wave, AF etc.) in 79 patients (79%), the association of various factors with mean values with ECG changes (Mean age, BMI, DBP, RBS) was more in patients with ECG changes than patients without ECG changes. However, this difference wasn't found to be statistically significant.

- by Laith G. Shareef
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- Emergency Medicine, ICU, ECG Signal processing

. Trend towards noninvasive, easy to use monitor was always a challenge. Numerous indices have been used to monitor the progress of patients on positive pressure ventilation. The present study compares different indices in a mixed larger intensive care unit (ICU) population. In a prospective observational study Arterial blood gases (ABG) analyses were obtained from 225 patients under mechanical ventilation in a polyvalent adult ICU. Values of ideal body weight (IBW), Body mass index (BMI), PAO 2, PaO 2 /FiO 2 ratio (PFr), SpO 2 /FiO 2 ratio (SFr), SpO 2 /PEEP ratio (SPr), SpO 2 /PaCO 2 ratio (SPCr), Oxy-genation index(OI) and Ventillatory ratio (VR) were calculated; and further correlation analysis was conducted. In Pressure control ventilation mode a relative strong relation between PFr and SFr and OI was found; yet further regression analysis implies that no direct replacement of PFr with SFr can be made without limitations, in clinical setting. In Volume control ventilation mode moderate relation was found between SFr and PFr. In the present study a moderate relation was found between SFr and

- by Theodoros Aslanidis
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- Respiratory Medicine, Anesthesiology, Carbon Dioxide, Critical Care
- by Delphine Holopherne-Doran
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- Heart rate variability, Prematurity, ICU, Sepsis

It is of utmost importance to protect our health-care professionals, who are the most important resources for any country today. The commitment behind this article and proposal is to ensure that we do not lose even one more doctor or nurse to COVID-19. In the opinion of the authors, the current design of most of the ICUs, where the air is recirculated through the air-conditioning, is not suited for treating the highly infectious patients of COVID-19, and may be one of the causes of the thousands of infections among the healthcare workers, which has also led to the death of over 500 of them around the world. One is not sure whether this is the reason behind the unusual death rate of patients put on ventilators too. This article proposes a cost-effective redesign of the existing ICUs and suggestions for choosing the buildings intended to be converted to makeshift hospitals to take care of the patients infected by the corona virus. Also, where the personal protective equipment is in sh...

- by Kanishq Sharma
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- Design, Occupational Health & Safety, Health Care Management, Medicine

Background: Mechanically ventilated patients often develop muscle weakness post-intensive care admission. Current evidence suggests that early mobilisation of these patients can be an effective intervention in improving their outcomes. However, what constitutes early mobilisation in mechanically ventilated patients (EM-MV) remains unclear. We aimed to systematically explore the definitions and activity types of EM-MV in the literature. Methods: Whittemore and Knafl’s framework guided this review. CINAHL, MEDLINE, EMBASE, PsycINFO, ASSIA, and Cochrane Library were searched to capture studies from 2000 to 2018, combined with hand search of grey literature and reference lists of included studies. The Critical Appraisal Skills Programme tools were used to assess the methodological quality of included studies. Data extraction and quality assessment of studies were performed independently by each reviewer before coming together in sub-groups for discussion and agreement. An inductive and ...

- by Catherine Clarissa
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- Psychology, Rehabilitation, Medicine, Critical Care

Introduction: Myocardial dysfunction occurs in about 40% of patients presenting with sepsis and septic shock. The most important hypothesis to explain it is based on a circulating myocardial depressant substance. Hypothesis: To evaluate the possibility of early diagnosis of myocardial dysfunction in patients in sepsis or septic shock using the transthoracic echocardiography or the brain Natriuretic peptide (BNP). Methods: 46 patients presented with severe sepsis or septic shock according to the criteria of the 2001 SCCM/ESICM/ACCP/ATS/SIS sepsis definition were included in the study. The patients undergone serial transthoracic Echocardiographic examinations, Sequential Organ Failure Assessment (SOFA score) and BNP measurements on admission to the ICU and till death or discharge. The patients were retrospectively divided into survivors and non survivors for statistical analysis of the sensitivity and specificity of the Echocardiographic data and the BNP in correlation to the SOFA score and the prognosis. Results: The mortality of patients with systolic left ventricular failure (LVEF < 55%) was 82.4%, in contrast to 51.7% in patients with normal systolic function. (p=0.037) Patients who had diastolic dysfunction on admission represented 39.1%. In the non survivors group 44.8% of them had diastolic dysfunction in comparison to 29.4% in the survivor group. The BNP in the survivor group ranged from 345.01±222.10 pg/ml on admission and increased till it reached a mean of 406.2±295.39 pg/ml at day 3 before decreasing to 163.69±134.39 pg/ml at discharge. The non-survivors had a higher mean which ranged from 708.62±305.17 pg/ml on admission to 1022.11±363.41 pg/ml at the third day. The BNP had a significant correlation with both the SOFA score (p=0.037) and delta SOFA score (p=0,025). A BNP level of 250.5 has a sensitivity of 82.8% and a specificity of 64.7% in predicting the mortality of patients in our study. Conclusion: BNP is sensitive but not specific for the diagnosis of heart failure and is correlated to the prognosis and SOFA score in patients admitted to the ICU with severe sepsis and septic shock. A cut off value of 250 pg/ml has a sensitivity of 82.8% and specificity of 64.7% in detecting the mortality of such patients. [Hassan Abu-Khabar, Mohammed Moustafa Abdel Salam Megahed and Ashraf Essam Roshdy. Septic Cardiomyopathy: Role of Echocardiography and Brain Natriuretic Peptide. Journal of American Science 2011; 7(12):47-62]. (ISSN: 1545-1003). http://www.americanscience.org. 7

- by Ashraf Roshdy
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- Emergency Medicine, Pulmonology, ICU, Chest
- by Charalampos T Martinos
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- Cardiothoracic Surgery, Medicine, Cardiac Surgery, ICU