Development Of Intensive Care Research Articles

Challenge in modern intensive care: chronic critical illness - pathophysiology and therapeutic options

The recent developments in intensive care have resulted in improved survival rates of patients treated with acute organ deficiency. As a consequence, the rate of those who survive the acute phase and subsequently require protracted organ support due to persisting organ dysfunction has been growing. Several survivors display chronic health status deterioration leading to prolonged rehabilitation or nursing, and repeated hospitalizations. The condition developed following the survival of the acute phase and requiring long-lasting intensive care is frequently termed as chronic critical illness (CCI). Several definitions exist, most of these are based on the number of ventilator days, or days of stay at the intensive care unit. Nevertheless, in spite of the initially heterogenous etiology of the acute illness, the complications associated with CCI, as well as the pathophysiological processes underlying these, are relatively uniform. This causes CCI to be a unique clinical syndrome characterized by the development of secondary infections, myopathy, central and peripheral neuropathy, and typical alterations of the hormonal and immune system functions. The outcome is heavily influenced by the frailty and comorbidities of the patient, in addition to the severity of the acute illness. The treatment of CCI patients presents a complicated task requiring multidisciplinary view and individualized therapeutic measures. Since the aging of the population and the continuously improving success rates in overcoming acute conditions also facilitate the development of CCI, the systematic overview of the underlying pathophysiological processes is pivotal for the optimization of the medical, nursing, social and economical burden presented by this syndrome. Orv Hetil. 2023; 164(18): 702-712.

Professor Igor V. Prianikov
 (08.04.1959-12.03.2021)

On March 12, 2021, at 62 years of age, a member of the editorial colleague of the journal Clinical Nutrition and Metabolism, a professor and a doctor of medical sciences Igor Valentinovich Pryanikov suddenly passed away.
 Igor Valentinovich made an invaluable contribution to the development of intensive care and medical rehabilitation of patients with the consequences of serious diseases, injuries and lesions of the central nervous system, the organization of a state system of measures aimed at reducing disability and mortality rates in the Russian Federation.

Совершенствование интенсивной терапии у пациентов с острым отравлением психодислептиками

Совершенствование интенсивной терапии у пациентов с острым отравлением психодислептиками

Development of Intensive Care in Low-Resource Regions

Since their introduction almost a century ago, intensive care units have become an essential part of the health care system. Although the majority are found in the high-income countries, access to intensive care in the low-income countries has improved. The purpose of this review is to report on the current state of intensive care in resource-limited settings. Lack of basic health care resources still poses a specific challenge to the development and sustainability of health care. In addition, adequate funding, human resource training, and equipment specific to the specialty of critical care pose an even larger setback to the development of critical care in low-resource-limited settings. Deaths potentially preventable with access to critical care as presented by data from the global disease burden analysis in 2004 are approximately 70% of all recorded deaths in low-income countries. This reflects the large burden of critical illness in low-income countries. Efforts to increase access to hospitals and intensive care for all critically ill patients should grow to match these needs.

The research progress of laryngotracheal stenosis in children

Children's laryngotracheal stenosis is the formation of laryngotracheal scar tissue caused by congenital or acquired factors, resulting in a narrow respiratory tract,which affects breathing. With the development of intensive care,tracheal intubation is widely used in premature infants and critically ill children.Therefore,the incidence of laryngotracheal stenosis in children has increased year by year.Children often need multiple steps of operations, poor surgical tolaerance, seriously affecting the quality of life of the whole family. This article summarizes the classification, etiology,clinical manifestations,diagnosis and treatment progress of children with laryngotracheal stenosis.

An examination of factors affecting the length of stay in long-term intensive care

With increased life expectancy, developments in intensive care (IC) and applications, there has been an increase in the length of stay of patients in IC Unit (ICU) in recent years. The aim of this study was to examine factors affecting the Length of Stay (LOS) in long-term ICU (LTICU)A total of 503 patients were included and the effects of variables were evaluated such as age, gender, comorbidities, tracheostomy, nutrition, mechanical ventilator (MV) support, and bacteria produced in cultures, which were predicted to have a clinical effect on the LOS in LTICU. The mean LOS in LTICU was 47.6±52.9 days. The LOS was determined to be increased 0.408-fold in patients with tracheostomy, 0.678-fold with Proteus spp production in cultures and 0.400-fold with E. coli production (p

Can qualitative research play a role in answering ethical questions in intensive care?

Scientific and technological progress, as well as increased patient autonomy have profoundly changed the world of healthcare, giving rise to new situations that are increasingly complex and uncertain. Quantitative paradigms, of which the main bastion is evidence-based medicine (EBM), are beginning to reach their limits in daily routine practice of medicine, and new approaches are emerging that can provide novel heuristic perspectives. Qualitative research approaches can be useful for apprehending new areas of knowledge that are fundamental to recent and future developments in intensive care.

Innovation and new trends in critical trauma disease

The management of critical trauma disease (CTD) has always trends the trends in military war experiences. These conflicts have historically revolutionized clinical concepts, clinical practice guidelines and medical devices, and have marked future lines of research and aspects of training and learning in severe trauma care. Moreover, in the civil setting, the development of intensive care, technological advances and the testing of our healthcare systems in the management of multiple victims, have also led to a need for innovation in our trauma care systems.

Non-Operative Management of Thoracoabdominal Gunshot Injury: Thirteen Unusual Cases

Background: Recently, the use of a surgical approach in injured patients has begun to be increasingly limited to unstable patients. Advances in imaging techniques and developments in intensive care have increased the applicability of non-operative treatment. Here, we aimed to present our clinical experience with different approaches in some patients. Method: Thirteen inpatients who had thoracoabdominal gunshot injuries but did not undergo emergency surgery between 2009 and 2014 were retrospectively evaluated. Results: Of the patients, nine (69.2%) were male and the mean age was 32.6 ± 9.7 years. The mean trauma-treatment interval was 51.2 ± 15.8 minutes. No surgical procedure was performed in 10 patients, four of whom had tangential injury. Diaphragmatic repair was performed in three patients after stabilization of solid organ injuries. The splenic and liver injuries were allowed to resolve itself through non-operative management, and there was no rush to repair the diaphragm until the splenic and liver recovery occurred. Four patients with tangential injury were shown not to have penetration of the abdominal cavity. Two pregnant patients, one with liver injury and the other with retroperitoneal injury, were successfully treated non-operatively. Conclusions: In centers that provide advanced conditions for emergency surgery, a conservative approach can be performed successfully in selected thoracoabdominal gunshot wound patients, including pregnant patients and those with splenic injuries. Tangential injuries can be managed non-operatively after penetration of cavities is ruled out. When diaphragmatic hernia is accompanied by liver or splenic injury, diaphragmatic repair can be delayed until these injures are restricted themselves. J Curr Surg. 2015;5(4):199-203 doi: http://dx.doi.org/10.14740/jcs281w

Innovación y nuevas tendencias en patología traumática crítica

The management of critical trauma disease (CTD) has always trends the trends in military war experiences. These conflicts have historically revolutionized clinical concepts, clinical practice guidelines and medical devices, and have marked future lines of research and aspects of training and learning in severe trauma care. Moreover, in the civil setting, the development of intensive care, technological advances and the testing of our healthcare systems in the management of multiple victims, hasve also led to a need for innovation in our trauma care systems.

The early development of pediatric intensive care

The polio epidemic in Copenhagen in 1952 was a significant stimulus to the development of Intensive Care. Eighty-five percent of the patients with respiratory involvement died despite the use of Cuirass negative pressure ventilators. After some controversy Ibsen, an anesthetist, was consulted. He found that many patients were dying with CO(2) retention. He advocated tracheostomy, suction, and ventilation. Owing to the lack of positive pressure ventilators, this was undertaken by students who contributed 167,000 h of hand ventilation. The mortality decreased to 25%. Anesthetists, having special experience with ventilation, became the leaders in the field as Intensive Care developed.

Three-year multicenter surveillance of community-acquired listeria monocytogenes meningitis in adults

BackgroundListeria monocytogenes is the third most frequent cause of bacterial meningitis. The aim of this study is to know the incidence and risk factors associated with development of acute community-acquired Lm meningitis in adult patients and to evaluate the clinical features, management, and outcome in this prospective case series.MethodsA descriptive, prospective, and multicentric study carried out in 9 hospitals in the Spanish Network for Research in Infectious Diseases (REIPI) over a 39-month period. All adults patients admitted to the participating hospitals with the diagnosis of acute community-acquired bacterial meningitis (Ac-ABM) were included in this study. All these cases were diagnosed on the basis of a compatible clinical picture and a positive cerebrospinal fluid (CSF) culture or blood culture. The patients were followed up until death or discharge from hospital.ResultsTwo hundred and seventy-eight patients with Ac-ABM were included. Forty-six episodes of Lm meningitis were identified in 46 adult patients. In the multivariate analysis only age (OR 1.026; 95% CI 1.00-1.05; p = 0.042), immunosupression (OR 2.520; 95% CI 1.05-6.00; p = 0.037), and CSF/blood glucose ratio (OR 39.42; 95% CI 4.01-387.50; p = 0.002) were independently associated with a Lm meningitis. The classic triad of fever, neck stiffness and altered mental status was present in 21 (49%) patients, 32% had focal neurological findings at presentation, 12% presented cerebellum dysfunction, and 9% had seizures. Twenty-nine (68%) patients were immunocompromised. Empirical antimicrobial therapy was intravenous ampicillin for 34 (79%) of 43 patients, in 11 (32%) of them associated to aminoglycosides. Definitive ampicillin plus gentamicin therapy was significantly associated with unfavourable outcome (67% vs 28%; p = 0.024) and a higher mortality (67% vs 32%; p = 0.040).The mortality rate was 28% (12 of 43 patients) and 5 of 31 (16.1%) surviving patients developed adverse clinical outcome.ConclusionsElderly or immunocompromised patients, and a higher CSF/blood glucose ratio in patients with Ac-ABM must alert clinicians about Lm aetiology. Furthermore, we observed a high incidence of acute community-acquired Lm meningitis in adults and the addition of aminoglycosides to treatment should be avoid in order to improve the patients' outcome. Nevertheless, despite developments in intensive care and antimicrobial therapy, this entity is still a serious disease that carries high morbidity and mortality rates.

Incidence of epilepsy in extremely low‐birthweight infants (<1,000 g): A population study of central and southern Sardinia

With the development of intensive care, the survival of extremely low-birthweight (ELBW) infants (<1,000 g) has greatly improved. The aim of our study was to report the incidence of epilepsy after a follow-up of >7 years in a population of ELBW children, born in central and southern Sardinia between 1991 and 2000. We analyzed data of 104 children. All infants had had serial cranial ultrasound echography (CUE) in the neonatal period and some also had magnetic resonance imaging (MRI). At last follow-up we evaluated the occurrence of epilepsy through a review of clinical charts and a structured telephone interview. In 11 (10.6%) of 104 of children we observed febrile seizures (FS). Epilepsy occurred in 9 (8.6%) of 104 ELBW children, and in these patients a frequent positive family history for epilepsy and/or FS was present. In four epilepsy patients CUE was highly pathologic, showing intraventricular hemorrhage (IVH) of grade IV and in two mildly abnormal (IVH of grade I-II). In three additional children with normal neonatal ultrasound scan, a later magnetic resonance imaging (MRI) study revealed lesions related to neonatal insult. In our ELBW population, epilepsy had an incidence clearly superior to that expected in infancy (8.6% vs. 0.6-0.8%). A frequent positive familiar history for epilepsy and/or FS suggests that a genetic predisposition may also play a role. Subjects with highly abnormal CUE are a subgroup with high risk for seizures; however, epilepsy can occur even with normal CUE.

Historical Perspectives

This month’s Historical Perspective is written by Osmund Reynolds. When I requested a personal reminiscence of how his research and article on detection of brain damage in preterm infants via cranial ultrasonography originated, I asked that he include the setting in which this advance occurred. His entertaining response provides a perspective on the evolution of neonatal care at University College Hospital (UCH), London. This recollection of the introduction of neonatal care at UCH is included in Part 1; part 2 focuses on the more specific introduction of cranial ultrasound imaging. It should be mentioned that the pace of development of neonatal intensive care in the United Kingdom generally was much slower than in the United States and some other countries. Indeed, in 1980, there were only 12 neonatal consultant posts for the entire UK. It is generally recognized that UCH was one of the leaders in this arena not only for the UK, but also for the world. For a more detailed discussion of the development of intensive care in the UK, the reader is referred to one in a series of “Witness Seminars” developed by the Wellcome Institute for the History of Medicine, for which Professor Reynolds was the major consultant. (1) 1. ↵ Origins of neonatal intensive care in the UK. In: Christie DA, Tansey EM, eds. Wellcome Witnesses to Twentieth Century Medicine. Vol.9 . London, United Kingdom: Wellcome Trust;2001 :1–75. [OpenUrl][1] # {#article-title-2} ### Introduction I first became interested in perinatal medicine in 1955 while undertaking a physiology BSc degree at St. Thomas’ Hospital Medical School in London. The head of the department was Professor Henry Barcroft (son of Sir Joseph), and Maureen Young was a lecturer. She taught me to measure blood gases using the Roughton-Scholander syringe; duplicate samples took about three quarters of an hour. After qualifying in medicine, I became a house physician on Professor Peter Sharpey-Shafer’s adult medical unit, which was an extremely stimulating environment with a very strong group of physiologically orientated investigators. Steve Semple taught … [1]: {openurl}?query=rft.jtitle%253DWellcome%2BWitnesses%2Bto%2BTwentieth%2BCentury%2BMedicine.%2B%26rft.volume%253D9%26rft.spage%253D1%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx

ICUs worldwide: a brief description of intensive care development in Argentina.

The present commentary reviews the development and present situation of critical care medicine in Argentina. Critical care has a long history in our country that began in 1958. Its development has not been uniform, and followed the political and economic troubles of the country, particularly those of its health system. Nevertheless, high quality care for critically ill patients, in both human and technological terms, has been achieved in Argentina.

Economically practical and critically necessary? The development of intensive care at Chestnut Hill Hospital.

Dans cet article, l'auteur explore le developpement du service de soins intensifs a l'Hopital de Chestnut Hill et examine le contexte dans lequel ce systeme technologique de soins pour les patients dans un etat critique se developpa.

How to equip a paediatric intensive care unit

The development of intensive care over the last 4 decades is the result of the tremendous progress in our understanding of the pathophysiology of the critically ill as well as the impact of new technology. It was not until the polio epidemic in the mid 1950s that general intensive care units began to appear in the USA and Scandinavia. The advances in mechanical ventilator technology allowed prolonged support for patients with respiratory failure and, subsequently it was realised that control of physiological parameters in patients was highly labour intensive. In the 1970s it became clear that sick children had their own special needs and the paediatric intensive care unit (PICU) was born. Establishing and tooling a PICU is a costly exercise. With the advances in the management of critically sick children, however, there has followed a drastic reduction in the mortality and morbidity of a multitude of conditions which were previously untreatable. The high cost of paediatric intensive care must be contained by centralising such services into large efficient units.

Development of intensive care (IC) scoring system in pediatric oncology patients (POP): [formula omitted], [formula omitted], [formula omitted]. Memorial Sloan-Kettering Cancer Center, NY, NY USA

Development of intensive care (IC) scoring system in pediatric oncology patients (POP): [formula omitted], [formula omitted], [formula omitted]. Memorial Sloan-Kettering Cancer Center, NY, NY USA

Developments in Intensive Care Nursing

In the next 10 years, the great thrust ill be in the development and use of nirrhanical devices and electronic units, the latter prowing out of the refinements of solid state. integrated circuit technology. This technical ogress will continue to affect the medical-surgical field, including those who care foi intensi\e caie patients who undergo complex intiacardiac surgery. Sirice 1952. pumps. such as the rotating disc oxygenator types, (which have coronary perfusion lines, presiu re Inanonieters, transistorized Telethermomete I, m t l heat exchanger) have enabled suipeons to coirect more life-threatening cardiac conditions. Also, since 1952, a1 tificial de ices have appeared on the intensive care scene. including the heart-assist pumps of Kantiowitz and IleBakey . These innovations were ,itlrinpts to keep the weakened heait functioning. As seen in Figure 1, the perfusion OK) peviatoi. ctombined with a frame to support a stietchei,