Journal of Critical Care Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Validation of Factors Affecting the Outcome of Cardiopulmonary Arrest in a Large, Urban, Academic Medical Center Mon, 27 Jan 2014 12:45:38 +0000 http://www.hindawi.com/journals/jccm/2014/168132/ Background. Recent studies of risks in cardiopulmonary arrest (CPA) have been performed using large databases from a broad mix of hospital settings. However, these risks might be different in a large, urban, academic medical center. We attempted to validate factors influencing outcomes from CPA at the University of Maryland Medical Center (UMMC). Methods. Retrospective chart review of all adult patients who underwent CPA between 2000 and 2005 at UMMC. Risk factors and outcomes were analyzed with appropriate statistical analysis and compared with published results. Results. 729 episodes of CPA were examined during the study period. Surgical patients had better survival than medical or cardiac patients. Intensive care unit' (ICU) patients had poor survival, but there was no difference on monitored or unmonitored floors. Respiratory etiologies survived better than cardiac etiologies. CPR duration and obesity were negatively correlated with outcome, while neurologic disease, trauma, and electrolyte imbalances improved survival. Age, gender, race, presence of a witness, presence of a monitor, comorbidities, or time of day of CPA did not influence survival, although age was associated with differences in comorbidities. Conclusions. UMMC risk factors for CPA survival differed from those in more broad-based studies. Care should be used when applying the results of database studies to specific medical institutions. Dafna Koldobskiy, Soleyah Groves, Steven M. Scharf, and Mark J. Cowan Copyright © 2014 Dafna Koldobskiy et al. All rights reserved. A National Survey of Pediatric Intensive Care Units in Pakistan Sun, 05 Jan 2014 13:34:55 +0000 http://www.hindawi.com/journals/jccm/2014/842050/ Purpose. To describe the structure, staffing resources, equipment, academic activities, and characteristics of pediatric population of pediatric intensive care units across the country. Material & Method. This was a prospective, descriptive, and observational survey of pediatric intensive care units from January to December 2009 across Pakistan. A questionnaire survey was emailed to director of each unit. Results. 16 PICUs were participated in this survey (100% response rate). A total of units with 155 beds were identified (1.1 bed /500,000 children). Regarding the categories, 12 (75%) were medical, 3 (19%) were pure cardiac intensive care units, and one unit (6%) was combined multidisciplinary cardiothoracic unit. 13 (81%) units were in public sector as compared to 3 (19%) were in private sector. The mean unit size was 9.7 (range 4–28) beds. Twelve (75%) units were located in three large cities. Only 3 (19%) units have trained intensivist. 37% (6/16) had nurse to patient ratio of 1 : 1-1 : 2 while others had ratios of 1 : 3–1 : 5 with all nurses specialized trained for pediatric intensive care units with bachelor degree or diploma in nursing. Only 50% had capacity for invasive monitoring. Conclusion. We found inadequacies in several aspects of PICUs in Pakistan including fewer PICUs, inadequate PICU beds, and lack of trained personal to look after critically ill pediatric population. Anwarul Haque, Laila A. Ladak, Muhammad H. Hamid, Sadiq Mirza, Naveed R. Siddiqui, and Zulfiqar A. Bhutta Copyright © 2014 Anwarul Haque et al. All rights reserved. Refractory Status Epilepticus: Experience in a Neurological Intensive Care Unit Thu, 02 Jan 2014 15:14:22 +0000 http://www.hindawi.com/journals/jccm/2014/821462/ Introduction. Refractory status epilepticus (RSE) has significant morbidity and mortality, and its management requires an accurate diagnosis and aggressive treatment. Objectives. To describe the experience of management of RSE in a neurological intensive care unit (NeuroICU) and determine predictors of short-term clinical outcome. Methods. We reviewed cases of RSE from September 2007 to December 2008. Management was titrated to findings on continuous video EEG (cVEEG). We collected patients’ demographics, RSE etiology, characteristics of seizures, cVEEG findings, treatments, and short-term outcome. Control of RSE was to achieve burst suppression pattern or electrographic cessation of ictal activity. Results. We included 80 patients; 63.8% were in coma, 25% had subclinical seizures, and 11.3% had focal activity. 51.3% were male and mean age was 45 years. Etiology was neurological lesion in 75.1%, uncontrolled epilepsy in 20%, and systemic derangements in 4.9%. 78.8% were treated with general anesthesia and concomitant anticonvulsant drugs. The control of RSE was 87.5% of patients. In-hospital mortality was 22.5%. The factors associated with unfavorable short-term outcome were coma and age over 60 years. Conclusions. RSE management guided by cVEEG is associated with a good seizure control. A multidisciplinary approach can help achieve a better short-term functional outcome in noncomatose patients. O. H. Hernandez, J. F. Zapata, M. Jimenez, M. Massaro, A. Guerra, J. C. Arango, J. D. Ciro, H. Delgado, and J. I. Suarez Copyright © 2014 O. H. Hernandez et al. All rights reserved.