http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Mon, 22 Apr 2013 11:27:04 +0000 http://www.hindawi.com/isrn/cc/2013/578316/ Background. Conditions of reduced perfusion are characterized by redistribution of blood flow away from the skin to more vital organs. Objectives. To assess the efficacy of a noninvasive, dermal blood flow (DBF) monitor in detecting changes in perfusion in critically ill patients. Methods. Eleven adult, critically ill patients in a general ICU were studied. DBF, finger plethysmography, and invasive mean arterial pressure (MAP) were recorded over an 8-hour period. DBF was measured using the DermaFlow DBF monitor via a skin probe placed on the anterior chest wall. Sensitivity was evaluated by visual inspection during active states, either induced, for example, fluid administration, or spontaneous, for example, altered hemodynamics, while specificity was evaluated during stable states. Data are expressed in terms of standard deviation of the difference (SDD) between the MAP and each of the tested methods. Results. The DBF detected all true changes detected by MAP while plethysmography detected fewer of these events. Based on SDD, the specificity of the DBF was found to be better than that of plethysmography and close in value to the MAP. Conclusions. This preliminary study suggests that the DBF monitor may be a useful noninvasive method for detecting changes in perfusion in critically ill patients. Jonathan Cohen, Ilya Skoletsky, Rina Chen, Daniel Weiss, and Pierre Singer Copyright © 2013 Jonathan Cohen et al. All rights reserved. Wed, 27 Mar 2013 15:09:07 +0000 http://www.hindawi.com/isrn/cc/2013/789601/ Introduction. Cardiopulmonary resuscitation (CPR) is acknowledged worldwide as a stressful clinical activity for all young doctors. The extent of standardisation of preparation for CPR within Australian curricula is unknown. Recent trends in the UK suggest the emergence of a common endpoint, Immediate Life Support (ILS) certification. The support for a similar shared endpoint in Australia is unknown. Methodology. A telephone questionnaire survey about the preparation for teaching CPR to medical students was undertaken in all Australian medical schools in early 2012; 88% of schools replied. Results. The majority favoured early basic CPR training. There was marked variation in how schools taught advanced CPR and how CPR competence was assessed. Only one school considered their graduates to be less than well prepared for CPR and all schools agreed that a common endpoint was desirable. Discussion. There is broad support for Immediate Life Support as a common end in resuscitation competence. Medical schools where students are prepared for a rural placement on graduation may still require a higher standard of competence. Peter J. M. Barton, Andrew A. Beveridge, and Kay M. Jones Copyright © 2013 Peter J. M. Barton et al. All rights reserved. Wed, 27 Mar 2013 08:28:52 +0000 http://www.hindawi.com/isrn/cc/2013/910125/ Background. Delirium is characterized by disturbances of consciousness, attention, cognition, and perception. Delirium is a serious but reversible condition associated with poor clinical outcomes. This has implications for the critically ill patient; the effects of delirium cause long term sequelae, principally cognitive deficits, and functional decline. Objectives. The objective of the paper was to describe risk factors associated with delirium in critically ill adult patients. Methods. Published and unpublished literature from 1990 to 2012, limited to English, was searched using ten databases. Results. Twenty-two studies were included in this paper. A large number of risk factors were presented in the literature; some of these were common across all settings whilst others were exclusive to the type of setting. Benzodiazepines and opioids were shown to be risk factors for delirium independent of setting. Conclusion. With regard to patients admitted to medical and surgical intensive care units, risk factors of older age and comorbidity were common. In the cardiac ICU, older age and lower Mini-Mental Status Examination scores were cited most often as risk factors for delirium, but other risk factors exclusive to the setting were also significant. Benzodiazepines were identified as the most significant pharmacological risk factor for delirium. Ihsan Mattar, Moon Fai Chan, and Charmaine Childs Copyright © 2013 Ihsan Mattar et al. All rights reserved. Tue, 15 Jan 2013 13:53:34 +0000 http://www.hindawi.com/isrn/cc/2013/382015/ Background. The anti-inflammatory effects of statin therapy may be beneficial in the treatment and prevention of acute respiratory distress syndrome (ARDS). Objectives. Determine if continuation or discontinuation of prior statin therapy is associated with ventilator-free days (VFDs) at day 28 in patients with ARDS. Methods. Patients with ARDS admitted to the intensive care units of a tertiary care medical center were evaluated in this retrospective cohort study. Included patients were allocated to three groups: patients in whom statin therapy was given before and continued after ARDS diagnosis (Group 1), patients with statin therapy only before ARDS diagnosis (Group 2), and patients never exposed to statins (Group 3). Results. Of 244 patients evaluated, 187 were included; 17 (9.1%) patients in Group 1, 20 (10.7%) in Group 2, and 150 in Group 3. There were no differences among groups in APACHE II or SOFA scores. VFDs were not significantly different among groups (median 0 versus 4.5 versus 13.5 days, ). After adjustment for baseline characteristics, including propensity for statin administration, statin therapy was not associated with increased VFDs on linear regression. Conclusions. Exposure to statins before or after ARDS diagnosis was not associated with improved VFDs in this cohort of patients with ARDS. Seth R. Bauer, Simon W. Lam, and Anita J. Reddy Copyright © 2013 Seth R. Bauer et al. All rights reserved. Thu, 29 Nov 2012 14:32:58 +0000 http://www.hindawi.com/isrn/cc/2013/857365/ Introduction. It is not yet a resolved issue whether HFOV (high-frequency oscillatory ventilation), used as primary mode or as rescue ventilation, has benefit over conventional mechanical ventilation for CDH (congenital diaphragmatic hernia) patients treatment. Purpose. To evaluate the success rate of rescue HFOV for CDH, and the histological characteristics of the lungs, at the autopsy of the deceased patients. Material and Methods. Out of 80 CDH patients, 10 were treated with rescue HFOV. The success of HFOV, histological exam of the lungs of deceased patients, and data on the followup of discharged patients were assessed. Results. Rescue HFOV was started between two hours and four days of life. The success rate of rescue HFOV was 20% (2/10). Autopsy findings along with pulmonary hypoplasia included coarctation of aorta , pneumonia , meconium aspiration , hyaline membranes , severe muscular hypertrophy of medium and small diameter lung arteries , severe lung hypoplasia , pleural effusions , haemorrhagic diatesis , and signs of overwhelming sepsis . The five-years follow up of the two survivors revealed normal growth and neurodevelopment. Conclusions. The results of this study support the idea that rescue HFOV may increase survival of CDH patients, when conventional mechanical ventilation fails. Gustavo Rocha, Jorge Correia-Pinto, and Hercília Guimarães Copyright © 2012 Gustavo Rocha et al. All rights reserved. Mon, 26 Nov 2012 14:59:15 +0000 http://www.hindawi.com/isrn/cc/2013/347346/ Purpose. The purpose of this project was to compare DDI severity for clinician opinion in the context of the patient’s clinical status to the severity of proprietary databases. Methods. This was a single-center, prospective evaluation of DDIs at a large, tertiary care academic medical center in a 10-bed cardiac intensive care unit (CCU). A pharmacist identified DDIs using two proprietary databases. The physicians and pharmacists caring for the patients evaluated the DDIs for severity while incorporating their clinical knowledge of the patient. Results. A total of 61 patients were included in the evaluation and experienced 769 DDIs. The most common DDIs included: aspirin/clopidogrel, aspirin/insulin, and aspirin/furosemide. Pharmacists ranked the DDIs identically 73.8% of the time, compared to the physicians who agreed 42.2% of the time. Pharmacists agreed with the more severe proprietary database scores for 14.8% of DDIs versus physicians at 7.3%. Overall, clinicians agreed with the proprietary database 20.6% of the time while clinicians ranked the DDIs lower than the database 77.3% of the time. Conclusions. Proprietary DDI databases generally label DDIs with a higher severity rating than bedside clinicians. Developing a DDI knowledgebase for CDSS requires consideration of the severity information source and should include the clinician. Michael J. Armahizer, Sandra L. Kane-Gill, Pamela L. Smithburger, Ananth M. Anthes, and Amy L. Seybert Copyright © 2013 Michael J. Armahizer et al. All rights reserved. Sun, 21 Oct 2012 13:25:18 +0000 http://www.hindawi.com/isrn/cc/2013/167468/ The diagnosis of brain death remains a clinical challenge for intensive care unit physicians. Worldwide regulations in its diagnosis may differ, and the need of ancillary tests after a clinical examination is not uniform. Transcranial sonography is a noninvasive, bedside, and widely available technique that can be used in the diagnosis of the cerebral circulatory arrest that preceeds brain death. In this paper we review the general concepts, the technical requisites, the patterns of Doppler signal confirming cerebral circulatory arrest, the vessels to insonate, and the options in cases with poor acoustic window. Future research perspectives in the field of transcranial sonography are discussed as well. Juan Antonio Llompart-Pou, Josep Maria Abadal, Albrecht Güenther, Luis Rayo, Juan Pedro Martín-del Rincón, Javier Homar, and Jon Pérez-Bárcena Copyright © 2013 Juan Antonio Llompart-Pou et al. All rights reserved. Thu, 30 Aug 2012 08:37:00 +0000 http://www.hindawi.com/isrn/cc/2013/137045/ Introduction. Admission to the ICU is a significant event for patients and their families and is often accompanied by stress, anxiety and depression. Literature shows that implementation of “unrestricted visiting policy” (UP) can potentially alleviate psychologically distressing elements of ICU admission. Methods. A web-based questionnaire was sent to all ICU’s concerning three main topics: general ICU information, detailed visiting policy information, and rationale for the chosen policy. Results. 87.1% (𝑛=74) of ICU’s retain “restricted visiting policies” (RVP; ≤five visiting hours per day). Knowledge about the current literature was overall 60.8%. There is an UP in two academic hospitals and a “partly restricted policy” (PRP; >5 visiting hours per day but <24) in two academic, two large teaching and five general hospitals. Mean permissible duration in ICU’s with a RVP was 165.6±79.2 min versus 487.5±126 min in the PRP. Conclusion. Nine out of ten ICU’s still have a restricted visiting policy. The main reasons cited for a restricted visiting policy were potential interference with the daily clinical routine and privacy. A better knowledge of the current literature in combination with infrastructural changes might improve patients’ outcome by reducing stress for the patient and its family. Kalinka Noordermeer, Tom A. Rijpstra, David Newhall, Aline J. M. Pelle, and Nardo J. M. van der Meer Copyright © 2013 Kalinka Noordermeer et al. All rights reserved.