Intensive Care Unit

Delirium poses a significant burden on our healthcare, with patients in the intensive care unit (ICU) at an increased risk for developing this disorder. In addition, the ICU environment poses unique challenges in the assessment of delirium. It is paramount that the healthcare provider has an understanding of delirium in ICU, and monitors for it vigilantly. There have been various scoring systems developed to assist in this regard. However, the most commonly used and validated tools for the assessment of delirium are the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC). Biomarkers of delirium are emerging as tools to diagnose delirium, stratify severity, monitor progress, and predict outcomes, potentially changing the way we approach delirium in the future.

Objectives: To describe the spectrum of complications of Diabetic Ketoacidosis (DKA) observed in children admitted with severe DKA. Methods: Retrospective review of the medical records of all children admitted with the diagnosis of severeDKA in Pediatric Intensive Care Unit (PICU) of DHQ teaching hospital Sargodha, from January 2010 to December 2015 was done. Data was collected on a structured proforma and descriptive statistics were applied. Results: Total 37 children were admitted with complicated DKA (1.9% of total PICU admission with 1.8% in2010 and 3.4% in 2015). Mean age of study population was 8.1±4.6 years and 70% were females (26/37). Mean Prism III score was 9.4±6, mean GCS on presentation was 11±3.8 and mean lowest pH was 7.00±0.15. Complications observed included hyperchloremia (35.94%), hypokalemia (30.81%), hyponatremia (26.70%), cerebral edema (16.43%), shock (13.35%), acute kidney injury (10.27%), arrhythmias (3.8%), and thrombotic thrombocytopenic purpura (5.4%), while one patient had myocarditis and ARDS each. 13/37 children (35%) needed inotropic support, 11/37 (30%) required mechanical ventilation while only one patient required renal replacement therapy. Two patients (5.4%) died during their PICU stay. Conclusion: Hyperchloremia and other electrolyte abnormalities, cerebral edema and AKI are the mostcommon complications of severe DKA.

Neonates in the neonatal intensive care unit (NICU) with a diagnosis of septicemia or fungemia are routinely screened to rule out ocular involvement. Risk factors of developing endophthalmitis in neonates include candidemia, bacteremia, retinopathy of prematurity, respiratory disorder, blood trans- fusion, fetal hemorrhage, and low birth weight. 12

Abstract: The elderly population is increasing in the developed world, therefore elderlies account for a considerable proportion of intensive care unit (ICU) admissions. A precise threshold for “elderly” is a matter of debate. The process of ageing is associated with physiological and functional alterations of the human body and organs that render elderly people vulnerable to infections. As a result of dysfunction of specific parts of immune response called immunosenescence, elderly patients may be threatened by severe infections. Chronic low-grade inflammation, termed inflammaging, is another contributor. In addition to these, comorbidities associated with increasing age, such as diabetes mellitus and immunosuppressive conditions pose an additive risk for infections and in some studies they were associated with increased mortality. Epidemiology of ICU infections may differ in elderlies, compared to other adults. Infections tend to be less microbiologically confirmed and site of infection may be obscure on presentation. The identified pathogens are frequently Gram-negative and particularly Enterobacteriaceae exhibiting a multidrug-resistant (MDR) phenotype. Multiple antibiotic prescriptions in this age-group, specific comorbidities (such as bronchiectasis or chronic obstructive pulmonary disease), residence in long term care facilities and frequent hospitalisations, are among others recognized risk factors for MDR infections. Data from two large European databases show that intra-abdominal infections are predominant among ICU infections in the elderly and Candida spp infections rank second, after Enterobacteriaceae. Age may pose important implications in treatment decisions. Organ derangements, physiological changes caused by increasing age and multiple concomitant medications call clinicians for vigilance about adverse events and toxicity. Despite all the above, elderlies in the ICU did not exhibit worse outcomes compared to younger counterparts in a straightforward manner. Studies however are heterogenous and most of them are single centers. As age is a continuous process, only analysis performed in subgroups of 65–74 (young-old elderlies), 75–84 (old elderlies) and >85 (old-old or oldest old elderlies) provides a better depiction of ICU outcomes. Most studies have shown a worse ICU outcome for the group of oldest-old elderlies, compared with young adults and elderlies in the range of 65 to 84 years of age. These data indicate that age per se may not represent a barrier in decisions concerning ICU admission and triage has to be done on an individual basis. However, epidemiological particularities of this age group should be taken into account in the selection of early and appropriate antimicrobial treatment, which will optimize patients’ outcomes.

A hospital intensive care unit (ICU) is designed to treat critically ill patients who need special care and treatment, sometimes at nearly the same extreme level required in an operating room[12,13]. ICUs contain many sources of noise, such as aspirators, monitors, mechanical ventilators, computers, printers, air conditioning vents, and others[14]. The adverse effects of elevated noise in hospitals have been documented in many researches, high noise levels interfere with communication, leads to attention loss, irritability, fatigue,

Work relationships among staff in a pediatric intensive care unit ( ICU ) are probably of critical importance to patient care, as well as to staff well-being.. Group dis- cussions were i[r]

P rognostication is central to developing a treat- ment plan and relaying information to pa- tients, family members, and other health care providers. A health care provider’s estimate of mor- tality risk is an important element in prognostication and care delivery to patients admitted to a pediatric intensive care unit (PICU). A more accurate assess- ment could lead to more appropriate monitoring, therapies, and family counseling. Similarly, the de- gree of confidence or certainty that a health care provider has with his or her assessment of mortality risk is also important, because a provider may de- liver care differently depending on his or her as- suredness in the mortality risk assessment. There- fore, risk assessment and its certainty have important implications for length of stay, quality of care, and cost of hospitalization.

Continuous renal replacement therapy (CRRT) was first described in 1977 for the treatment of diuretic-unresponsive fluid overload in the intensive care unit (ICU). Since that time this treatment has undergone a remarkable technical and conceptual evolution. It is now available in most tertiary ICUs around the world and has almost completely replaced intermittent haemodialysis (IHD) in some countries. Specially made machines are now available, and venovenous therapies that use blood pumps have replaced simpler techniques. Although, it remains controversial whether CRRT decreases mortality when compared with IHD, much evidence suggests that it is physiologically superior. The use of CRRT has also spurred renewed interest in the broader concept of blood purification, particularly in septic states. Experimental evidence suggests that this is a promising approach to the management of septic shock in critically ill patients. The evolution and use of CRRT is likely to continue and grow over the next decade.

The use of sensory rooms in psychiatric settings is becoming more widespread, with the introduction of sensory rooms reported in different countries including: the USA (Champagne & Sayer 2003; Costa et al. 2006); New Zealand (Sutton & Nicholson, 2011; Te Pou o te Whakarro, 2011); and Australia (Chalmers et al. 2012; Novak et al. 2012). The purpose of this article is to discuss the findings of a research study conducted in the UK that explored the use of a sensory room on an Intensive Care Unit (ICU) (known as a Psychiatric Intensive Care Unit (PICU) in the UK), with a particular focus on the impact on seclusion rates and staff and patients’ experiences of using the sensory room.

Infections are an everyday problem in the intensive care unit (ICU) and antibiotics are therefore commonly used in this setting. [7] The present study was done in 300 patients admitted in Medicine ICU in Rajarajeswari Medical college and hospital where we found that female admission were more than males with a mean age of 55 years. This is in contrast to the studies conducted in Nepal. [8] Which showed male predominance. Smythe et al. study showed equal number of male and female patients admitted with a mean age of 65 years. [9] Other Indian study reported male predominance. [10]

Evidence exists that appropriate nurse staffing in the NICU is associated with decreased rates of central line–associated bloodstream infections (Cimiotti, Haas, Saiman, & Larson, 2006), higher achievement of oxygen saturation goals (Sink, Hope, & Hagadorn, 2011), and reduced risk-adjusted mortality rates (Hamilton, Redshaw, & Tarnow-Mordi, 2007). Specific data for other neonatal outcome measures are either equivocal or do not exist. Nonetheless, a growing body of evidence suggests that the effect of higher nurse staffing is strong and consistent in intensive care units and for surgical patients (Kane, Shamliyan, Mueller, Duval, & Wilt, 2007). Although neonatal patients have not been studied as a specific population, similar outcomes can reasonably be expected in the neonatal intensive care unit (NICU).

These data suggest that sibling visiting to a neonatal intensive care unit is not likely to be harmful and might be beneficial to the siblings and their families.. Pediatrics 1983;71:835[r]

Visiting a patient in the Intensive Care Unit (ICU) may be an unfamiliar experience for many families and friends.What you may notice first is a room filled with complicated and strange equipment.Take comfort in knowing that the highly-skilled men and women who use these life-saving machines to benefit our patients make up Regional’s Critical Care Team. Here is a list of people you are likely to see and a brief description of what they do. Get to know the people taking care of your loved one.

Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained health care professionals to provide specialized care for the tiniest patients. NICUs may also have intermediate or continuing care areas for babies who are not as sick but do need specialized nursing care. Some hospitals do not have the personnel or a NICU and babies must be transferred to another hospital.

nursing staff of public and private institutions to know their opinion about the need for a dentist integrating the team and in response, 86% consider their necessary presence. (Pace et al., 2008). This can be confirmed in a survey conducted in large public hospital where the medical clinic have 46 beds. In semi- structured interviews and non-participant observation of the nursing staff working in medical and surgical clinic. During the research period there was no offering dental care to these patients by nurses, found out in the structured observation, that nursing technicians take on average per shift 10-12 patients with all types of addictions. And they say that there is work overload and it undermines the execution of basic care such as oral hygiene and other bodily higienes (Passos et al., 2011). Other research that relates to oral care and practices carried out by staff of the intensive care unit involving professionals working in the ICU of public and private hospitals, two hospitals with ICU, accounting for 25 beds with an average of 40 workers per team, and these professionals; 2 doctors, seven physiotherapists, one psychologist, 10 nurses, nursing 21técnico and 2 auxiliary nurse providing care continues, with 84 % of these professionals have to admit the presence of a dentist present in the ICU (Cortizo et al., 2014).

Although many promising objective methods (measuring systems) are available, there are no truly validated instruments for monitoring intensive care unit (ICU) sedation. Auditory evoked potentials can be used only for research in patients with a deep level of sedation. Other measuring systems require further development and validation to be useful in the ICU. Continuing research will provide an objective system to improve the monitoring and controlling of this essential treatment for ICU patients. Subjective methods (scoring systems) that are based on clinical observation have proven their usefulness in guiding sedative therapy. The Glasgow Coma Score modified by Cook and Palma (GCSC) achieves good face validity and reliability, which assures its clinical utility for routine practice and research. Other scales, in particular the Ramsay Scale, can be recommended preferably for clinical use. An accurate use of available instruments can improve the sedative treatment that we deliver to our patients.

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dys- function in critically ill patients, occurring in up to 80% of the sickest intensive care unit (ICU) populations. Critically ill patients are subject to numerous risk factors for delirium. Some of these, such as exposure to sedative and analgesic medications, may be modified to reduce risk. Although dysfunction of other organ systems continues to receive more clinical attention, delirium is now recognized to be a significant contributor to morbidity and mortality in the ICU, and it is recommended that all ICU patients be monitored using a validated delirium assessment instrument. Patients with delirium have longer hospital stays and lower 6- month survival than do patients without delirium, and preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge. Little evidence exists regarding the prevention and treatment of delirium in the ICU, but multicomponent interventions reduce the incidence of delirium in non-ICU studies. Strategies for the prevention and treatment of ICU delirium are the subjects of multiple ongoing investigations.

The ultimate question is whether nutritional support improves patient outcome, and, specifically, whether nutritional support lowers mortality and mobility and reduces intensive care unit and hospital durations of stay. Unfortunately, there are no definitive large multicenter studies that have examined this issue. There are a few meta-analyses and large studies that have examined selected aspects of nutritional support. A recent study [118] claimed that starting enteral nutrition within 3 days of intensive care unit admission reduces duration of mechanical ventilation and improves outcome. A meta- analysis using 26 studies [119] examined the relationship between TPN and standard care (usual oral diet plus intravenous dextrose), and complications and mortality rates in surgical and critically ill patients. TPN had no effect on mortality and only lowered complication rates in malnourished patients. Studies published before 1988 had significant treatment effect, whereas those published after 1989 did not. Complication rates, but not mortality, were lower among patients who did not receive lipids. Another meta-analysis of 11 randomized trials of both critically ill and gastrointestinal malignancy patients [120] examined the issue of immunonutrition (ie enteral nutrition supple- mented with arginine, ω 3 fatty acids and purines). This formulation is purported to improve immune function and showed significant reductions in the risk of developing infectious complications and in hospital stay. No effect on mortality was observed.

Results: Incidence: hypophosphatemia is frequently encountered in the intensive care unit; and critically ill patients are at increased risk for developing hypophosphatemia due to the presence of multiple causal factors. Symptoms: hypophosphatemia may lead to a multitude of symptoms, including cardiac and respiratory failure. Treatment: hypophosphatemia is generally corrected when it is symptomatic or severe. However, although multiple studies confirm the efficacy and safety of intravenous phosphate administration, it remains uncertain when and how to correct hypophosphatemia. Outcome: in some studies, hypophosphatemia was associated with higher mortality; a paucity of randomized controlled evidence exists for whether correction of hypophosphatemia improves the outcome in critically ill patients.

We want you to feel welcome in the Neuroscience/Trauma Intensive Care Unit (6ICU). Your healthcare team understands that this is a difficult time for you. While your loved one is in 6ICU, he or she will be monitored closely. We are committed to delivering the highest level of care to you and your loved one.