Years In Intensive Care Unit Research Articles

Early trigger diagnosis by diaphragmatic ultrasound

Mechanical ventilation is one of the most widespread and characteristic procedures in intensive care units (ICU). Proper understanding of ventilator waveforms is very helpful in achieving protective ventilation for both the lung and the diaphragm, and in many cases improving patient-ventilator interaction. Ultrasound has taken on great importance in recent years in ICU because it is accessible and non-invasive. Sonographic evaluation of the diaphragm is helpful in assessing its function and can also be useful in detecting and correcting possible asynchronies. Early trigger is a particular kind of asynchrony that occurs when a ventilator insufflation precedes the patient trigger effort. Keywords: ventilator waveforms, ultrasound, diaphragm, asynchrony, early trigger.

Presepsin is a more useful predictor of septic AKI and ARDS for very-old sepsis patients than for young sepsis patients in ICUs: a pilot study

ObjectiveSepsis is a syndrome of life-threatening organ dysfunction. This study aimed to determine whether presepsin is a useful predictor of septic acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and shock in very-old sepsis patients aged 75 years in intensive care units (ICUs).ResultsA total of 83 adult patients diagnosed with sepsis were prospectively examined and divided into two groups: those aged 75 years and older (over 75 group) and those aged younger than 75 years (under 75 group). Presepsin values were measured after ICU admission. Inflammation-based prognostic scores were also examined. For category classification, total scores (“inflammation-presepsin scores [iPS]”) were calculated. Presepsin values, inflammation-based prognostic scores, and iPS were compared between patients with septic AKI, ARDS, DIC, or shock and those without these disorders in the over 75 and under 75 groups. Areas under the curve of presepsin for predicting septic AKI and ARDS in the over 75 group were both > 0.7, which were significantly higher than those in the under 75 group. In conclusion, presepsin is a more useful predictor of septic AKI and ARDS for very-old sepsis patients (over 75 years) than for younger sepsis patients (under 75 years).

Acute kidney injury comorbidity analysis based on international classification of diseases-10 codes.

Acute kidney injury (AKI) is a clinical syndrome that occurs as a result of a dramatic decline in kidney function caused by a variety of etiological factors. Its main biomarkers, serum creatinine and urine output, are not effective in diagnosing early AKI. For this reason, this study provides insight into this syndrome by exploring the comorbidities of AKI, which may facilitate the early diagnosis of AKI. In addition, organ crosstalk in AKI was systematically explored based on comorbidities to obtain clinically reliable results. We collected data from the Medical Information Mart for Intensive Care-IV database on patients aged [Formula: see text] 18 years in intensive care units (ICU) who were diagnosed with AKI using the criteria proposed by Kidney Disease: Improving Global Outcomes. The Apriori algorithm was used to mine association rules on the diagnoses of 55,486 AKI and non-AKI patients in the ICU. The comorbidities of AKI mined were validated through the Electronic Intensive Care Unit database, the Colombian Open Health Database, and medical literature, after which comorbidity results were visualized using a disease network. Finally, organ diseases were identified and classified from comorbidities to investigate renal crosstalk with other distant organs in AKI. We found 579 AKI comorbidities, and the main ones were disorders of lipoprotein metabolism, essential hypertension, and disorders of fluid, electrolyte, and acid-base balance. Of the 579 comorbidities, 554 were verifiable and 25 were new and not previously reported. In addition, crosstalk between the kidneys and distant non-renal organs including the liver, heart, brain, lungs, and gut was observed in AKI with the strongest heart-kidney crosstalk, followed by lung-kidney crosstalk. The comorbidities mined in this study using association rules are scientific and may be used for the early diagnosis of AKI and the construction of AKI predictive models. Furthermore, the organ crosstalk results obtained through comorbidities may provide supporting information for the management of short- and long-term treatment practices for organ dysfunction.

Pediatric in-hospital cardiac arrest: Respiratory failure characteristics and association with outcomes

AimsTo characterize respiratory failure prior to pediatric in-hospital cardiac arrest (IHCA) and to associate pre-arrest respiratory failure characteristics with survival outcomes. MethodsThis is a single-center, retrospective cohort study from a prospectively identified cohort of children <18 years in intensive care units (ICUs) who received cardiopulmonary resuscitation (CPR) for ≥1 minute between January 1, 2017 and June 30, 2021, and were receiving invasive mechanical ventilation (IMV) in the hour prior to IHCA. Patient characteristics, ventilatory support and gas exchange immediately pre-arrest were described and their association with the return of spontaneous circulation (ROSC) was measured. ResultsIn the 187 events among 154 individual patients, the median age was 0.9 [0.2, 2.4] years, and CPR duration was 7.5 [3, 29] minutes. Respiratory failure was acute prior to 106/187 (56.7%) events, and the primary indication for IMV was respiratory in nature in 107/187 (57.2%) events. Immediately pre-arrest, the median positive end-expiratory pressure was 8 [5, 10] cmH2O; mean airway pressure was 13 [10,18] cmH2O; peak inspiratory pressure was 28 [24, 35] cmH2O; and fraction of inhaled oxygen (FiO2) was 0.40 [0.25, 0.80]. Pre-arrest FiO2 was lower in patients with ROSC vs. without ROSC (0.30 vs. 0.99; p < 0.001). Patients without ROSC had greater severity of pre-arrest oxygenation failure (p < 0.001) as defined by oxygenation index, oxygen saturation index, P/F ratio or S/F ratio. ConclusionsThere was substantial heterogeneity in respiratory failure characteristics and ventilatory requirements pre-arrest. Higher pre-arrest oxygen requirement and greater degree of oxygenation failure were associated with worse survival outcomes.

Evaluation of moral sensitivity and moral courage in intensive care nurses in Turkey during the COVID-19 pandemic.

BackgroundDuring the COVID‐19 pandemic, intensive care nurses may experience ethical issues related to fear of transmission, limited resources, and increased workload. Nurses' moral sensitivity and courage may have a role in dealing with these problems.Aim and ObjectiveThe purpose of this study was to assess intensive care nurses' moral sensitivity and moral courage during the COVID‐19 pandemic.DesignDescriptive cross‐sectional survey.MethodsA total of 362 nurses working in the intensive care units of pandemic hospitals in Turkey participated in the study between January and March 2021. Data were obtained using a personal information form, the Moral Sensitivity Questionnaire, and the Nurses' Moral Courage Scale. A link to the online data collection tools was sent to the management of participating institutions, who forwarded it to nurses. Reporting followed the CHERRIES guidelines.ResultsIn this study, the response rate of nurses was 89%. The nurses' total mean moral sensitivity score was 90.70 ± 28.89 and their mean moral courage score was 82.08 ± 13.51. A weak inverse correlation was found between the nurses' moral sensitivity and moral courage scores (r = −.176, p = .001). Total moral sensitivity score differed significantly according to years of Intensive care unit (ICU) experience (p = .007). Total moral courage scores increased significantly with education level (p = .012), years of nursing experience (p = .016), and willingness to work in the ICU (p < .001).ConclusionThe study suggests that nurses working in the intensive care unit during the pandemic had moderate moral sensitivity and high levels of moral courage. Nurses' sociodemographic characteristics and ICU work conditions may affect their moral sensitivity and moral courage.Relevance to Clinical PracticeThe results of this study can help guide efforts to improve moral courage and sensitivity and address ethical issues among ICU nurses.

Implementing AACN's Healthy Work Environment Framework in an Intensive Care Unit.

Bedside nurse turnover in the United States is 15.9%, representing a national challenge that has been attributed to poor work environments. Healthy work environments are associated with improved nurse satisfaction and retention as well as positive patient outcomes; unhealthy work environments have the opposite effects. To implement the American Association of Critical-Care Nurses (AACN) healthy work environment (HWE) framework in an intensive care unit and to evaluate staff satisfaction, turnover, and tenure 2 years later. A pre-post study design was used to evaluate implementation of the HWE framework in an intensive care unit in a large academic medical facility. Interventions for each of the 6 HWE standards were performed. The AACN HWE assessment survey was used to measure skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership in 2017 and in 2019. Nurse cohorts (n = 165 in 2017; n = 176 in 2019) had a mean age of 31 (median, 27; range, 23-63) years, were predominantly female (76%), and had a mean of 5 (median, 3) years of intensive care unit nursing experience. Statistically significant improvements were found in all standards except the skilled communication and overall measures. Registered nurse turnover remained stable and tenure increased by 79 days in this 2-year period. Findings from this study suggest that interventions addressing the HWE standards are associated with improved staff satisfaction, turnover, and average tenure, further demonstrating the value of the HWE framework in improving retention.

Depressive and Anxiety Symptoms of Healthcare Workers in Intensive Care Unit Under the COVID-19 Epidemic: An Online Cross-Sectional Study in China.

Background: Since the coronavirus disease-2019 (COVID-19) outbreak, intensive care unit (ICU) healthcare workers were responsible for the critical infected patients. However, few studies focused on the mental health of ICU healthcare workers. This study aimed to investigate the psychological impact of COVID-19 on ICU healthcare workers in China.Methods: We distributed the nine-item Patient Health Questionnaire (PHQ-9) and seven-item General Anxiety Disorder questionnaire (GAD-7) online to ICU healthcare workers in China. Respondents were divided into frontline and second-line according to whether they have contact with COVID-19 patients. Depressive and anxiety symptoms of all respondents were evaluated based on their questionnaire scores.Results: There were 731 ICU healthcare workers finally enrolled in our study, including 303 (41.5%) male, 383 (52.4%) doctors, and 617 (84.4%) aged 26–45 years. All in all, 482 (65.9%) ICU healthcare workers reported symptoms of depression, while 429 (58.7%) reported anxiety. There was no significant difference between frontline (n = 325) and second-line (n = 406) respondents in depression (P = 0.15) and anxiety severity (P = 0.56). Logistic regression analysis showed that being female, ICU work time >5 years, and night duty number ≥10 were risk factors of developing depressive and anxiety symptoms. Income reduction was separately identified as risk of anxiety. Additionally, ICU work time >5 years was also identified as risk of developing moderate–severe depressive and anxiety symptoms.Conclusions: Frontline ICU work was not associated with higher risk of depressive and anxiety symptoms during COVID-19 pandemic remission period in China. Actions like controlling night duty number, ensuring vacation, and increasing income should be taken to relieve mental health problem. Furthermore, we should pay close attention to those who had worked long years in ICU.

Evaluation of Nurses’ Knowledge and Attitudes toward Pain Management at Baghdad Teaching Hospitals

Poorly managed or unmanaged pain is a problem that affects individuals, entire healthcare systems and societies throughout the world . Objectives: To assess nurses’ knowledge and attitudes about patient’s pain management and to find out the relationship between knowledge , attitudes and their demographical characteristic. Methodology: A descriptive cross sectional design study was carried out among 100 nurses working in male and female surgical wards, ICU, surgical ward, emergency and operating theatre of four teaching hospitals, Baghdad city. Census method was used to select the participants, in which all the nurses working in the selected wards who agreed to participate in the study were selected. Data was collected by distributing structured self-administered questionnaire which was a modified form of a standard tool, that is, Nurses’ Knowledge and Attitude Survey Regarding Pain (NKASRP) developed by Ferrel and McCaffery. Results: The majority of the study were male who accounted for (63%) of the total participants while female constituted (37%). Most of participants (49%) were ages between (18 – 27) years old, a high percentage of them were have institute graduate (40%), (50%) of the nurses were single and the remainder was married. Majority of them (37%) were employee (1-5) years in employment in nursing. Majority of them (45%) were employee (1-5) years in intensive care unit, and finally majority of nurses (77%) have training session about patient’s pain management. Conclusions: This study indicated that nurses’ have poor knowledge about pain management, as well as study indicated overall nurses’ have positive attitudes toward pain management.

Yoğun Bakım Hemşirelerinin Örgütsel Yenilik Düzeylerinin İncelenmesi

Aim: The aim of this study was to investigate intensive care nurses’ organizational innovation levels. Methods: This descriptive study was conducted with 90 nurses working in the Intensive Care Units of a Training and Research Hospital in Ankara. Data were collected by Descriptive Information Form and Organizational Innovation Scale. Descriptive statistics, One-Way ANOVA test, Mann-Whitney U test and Kruskal-Wallis test were used to evaluate the data. Results: The mean age of participants was 28.01±5.6. It was found that most of the participants (68.9%) did not use resources effectively for innovative practices and 66.7% of them did not intend to develop a project related to innovative practices. Eighty-eight percent of participants stated that intensive care units are suitable places for innovative practices. There was no statistically significant difference between age, marital status, educational status, occupational year, working year in intensive care unit with organizational innovation sub-scales (p&lt;0.05). Conclusion: According to this study, intensive care nurses’ socio-demographic characteristics such as age, marital status, education level, occupational year and working time in intensive care did not affect their organizational innovation tendencies.

Factors Influencing How Intensive Care Unit Nurses Allocate Their Time.

Spending time with the patient is essential for intensive care unit (ICU) nurses to detect clinical change. This article reports on an examination of factors influencing nurses' activity time allocation. Data were analyzed from a prospective time and motion study of medical ICU nurses. Nurse demographic data and observation, electronic locator technology, and electronic medical record log data were collected over 12 days from 11 registered nurses. Charlson Co-Morbidity Index and Sequential Organ Failure Assessment scores were calculated for patient assignments. Nurses averaged 78.04 (SD = 47.85) min per patient on activities in the patient room. Years of ICU nursing experience and the patient's Charlson Co-Morbidity Index was significantly associated with time spent in the patient's room. Neither nursing education nor specialty certification was found to influence time spent in a patient's room. Using technology can advance understanding of nurses' time allocation leading to interventions optimizing time spent with the patient.

Frequency of Burnout Syndrome in an Intensive Care Unit of a Tertiary Care Hospital in Dhaka, Bangladesh

Background: Burnout syndrome is a psychological term resulting from prolonged exposure to job stressors. It is a very common problem among health professionals especially intensive care unit (ICU) staffs (physicians, nurses, ward-attendant), as ICUs are characterized by a high level of work related stress. The consequences associated with professional burnout affect both the healthcare professionals and recipients.&#x0D; Methods: This cross-sectional study was done over the period of four months (April to July, 2017) in the department of Critical Care Medicine, of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM) General Hospital, Dhaka. Total 93 ICU staffs were included as study population. After taking informed written consent, the participants were given a structured questionnaire consisting of 2 parts. Part 1 addressed demographic information including gender, age, credentials, employment status, years in practice, work schedule, hours worked per week, smoking and alcohol habit, involvement in teaching and research works. Part 2 of the handout was the Maslach Burnout Inventory - Human Service Survey (MBI-HSS); an inventory consisting of 22 questions to assess three components of burnout.&#x0D; Results: Among the 93 study participants 39.8% were physicians, 47.3% were nurses and 12.9% were wardattendants) were included in this study. Majority (52.7%) of the responders were found in the age group 20-29 year and 58.1% were married. Majority (58.1%) had a working experience of 1-5 year in ICU, where 61.3% staff had 20-25 working days/month. Regarding duty schedule, 84.9% staff were doing shifting duty, 83.9% had 6-10 working night shifts/month. Most (62.4%) were involved in 1-5 patients’ care during their duty time. Among all responders, 17.2% had habit of smoking and 4.3% had alcohol intake habit. 56.7% physicians were involved in research works, and 41.9% of total physicians and nurses were involved in teaching activities. Mostly (97.8% of all staff) followed the ICU guidelines. Regarding burnout scale, 50.5% of the staff had been suffering from moderate emotional exhaustion (EE), 46.2% of high EE. Majority (38.7%) had been suffering from low depersonalization (DP), 32.3% were in high DP and 29.0% were in moderate DP; 81.7% scored high on the personal accomplishment (PA) subscale.&#x0D; Conclusion: This study results suggest that majority of ICU staff are affected by some level of burnout syndrome.&#x0D; Birdem Med J 2019; 9(1): 30-34

Neuro-orthopedics disorders in intensive care unit (ICU): Perceptions of teams

Objective In intensive care unit (ICU), the frequent association of organ failure, neurological, orthopedic lesions and undernutrition promotes the development of neuro-orthopedic disorders (NOD). They can affect the acute phase management and the functional prognosis of patients. Caregivers (nurses and nursing auxiliaries) have a sentinel role in their early detection. Material/patients and methods We investigated the perception of paramedical and medical teams in 3 surgical ICU in university hospitals in Ile-de-France. Questionnaires were about the impact of the NOD on patient health and on care as well as on the therapeutic or preventive actions carried out. Results In total, 79 questionnaires including: nurses (n = 30, median age = 28.5 [23–49]), nursing auxiliaries (n = 17, median age = 31 [20–56]), doctors (n = 28, median age = 32.5 [24–60]) and physiotherapists (n = 4, median age = 50 [26–53]). Among caregivers, 64% have been working for less than 5 years in ICU and 46.8% consider NOD to be frequently responsible for pain. There is a correlation between age and the perception of NOD responsibility in pain for caregivers (P = 0.04), but not for doctors (P = 0.26). We do not find correlation between the experience in ICU and the perception of NOD responsibility in pain (P = 0.77), nor between the impact of NOD on pain and the tendency to start action against the NOD from caregivers (modification of the positioning P = 0.26 or mobilization by caregivers P = 0.57). Discussion – conclusion The number of responses seems to indicate that ICU teams are interested in NOD. Some results are surprising, with sometimes high variability. Although the methodology (question formulation, subjective declarative data, etc.) induces biases, we may wonder why age seems to influence the perception of the role of NOD in pain, contrary to the experience in ICU or why the pain does not seem to induce modifications of positioning or mobilization by the caregivers. It seems necessary to compare these data with a prospective study to determine the prevalence of NOD in ICU, or even to define a patient profile at risk of developing NOD in ICU.

Analysis on Acinetobacter baumannii infcetions and drug susceptibility in intensive care unit

Objective To study the infection situation of acinetobacter baumannii and the drug susceptibility in intensive care unit (ICU), and to provide reference for rational use of antibiotics in clinic. Methods A retrospective study was conducted.acinetobacter baumannii separated in ICU of Erduosi Central Hospital from January 2013 to December 2015 were collected.In the study of these 3 years in ICU, the situation of acinetobacter baumannii infection and the acinetobacter baumannii susceptibility to drugs were analyzed. Results One hundred and two strains acinetobacter baumannii were isolated in 3 years, acinetobacter baumannii was mainly isolated in sputum samples in 77 cases which accounted for 75.5%.And other 10 strains were isolated in urine, accounted for 9.8%.7 strains were isolated in secretion, which accounted for 6.9%.The isolation rate of acinetobacter baumannii was increased year by year.The highest rate of susceptibility was to tigecycline, with a susceptibility rate of 95.1%, followed by cefoperazone-sulbactm, with the rate of 40.2%, and to imipenem was 35.3%.Susceptibility of acinetobacter baumannii isolated was less than 40.0% for antibiotic commonly used. Conclusion In ICU, the rate of acinetobacter baumannii infection increased annually and the infection was mainly in the respiratory tract.The susceptibility of tigecycline to acinetobacter baumannii was the highest, and its susceptibility to clinical commonly used antibiotics was poor. Key words: Infection; Intensive care unit; Microbial sensitivity tests

Zinc Supplementation in Adult Mechanically Ventilated Trauma Patients is Associated with Decreased Occurrence of Ventilator-associated Pneumonia: A Secondary Analysis of a Prospective, Observational Study.

Background:Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the Intensive Care Unit (ICU). The aim of this analysis is to determine potential association between zinc supplementation with the occurrence of VAP in adult mechanically ventilated trauma patients.Subjects and Methods:This secondary analysis of a prospective observational study was carried out over a period of 1 year in ICUs of one teaching hospital in Iran. A total of 186 adults mechanically ventilated trauma patients, who required at least 48 h of MV and received zinc sulfate supplement (n = 82) or not (n = 104) during their ICU stay, were monitored for the occurrence of VAP until their discharge from the ICU or death.Results:Forty-one of 186 patients developed VAP, 29.09 days after admission (95% confidence interval [CI]: 26.27–31.9). The overall incidence of VAP was 18.82 cases per 1000 days of intubation (95% CI: 13.86–25.57). Patients who received zinc sulfate supplement have smaller hazard of progression to VAP than others (hazard ratio: 0.318 [95% CI: 0.138–0.732]; P < 0.0001).Conclusion:The findings show that zinc supplementation may be associated with a significant reduction in the occurrence of VAP in adult mechanically ventilated trauma patients. Further well-designed randomized clinical trials to confirm the efficacy of this potential preventive modality are warranted.

Palliative care and intensive care integration

With developments in technology and in healthcare policies in Turkey, both the quality and number of applications of care have increased in recent years in intensive care units. At the same time, rates of hospital mortality have increased due to the rise in the elderly population, changes in family structure, increased urban population and easier access to health facilities. Intensive care units are the places where deaths and functional and cognitive disorders are most frequently seen. Current models where intensive care and palliative care are integrated are seen as an important component of comprehensive care for patients with critical disease and who are receiving aggressive intensive care treatment. The goal in intensive care and palliative care integration is to promote better quality, lower cost, patient and family satisfaction. The aim of this review was to highlight the importance and necessity of palliative care applications in intensive care units. It can be concluded that an increase in palliative care training, legal regulations made related to end-of-life patient care and the implementation of palliative care in intensive care unit would provide more effective use of intensive care units.

Implementation and Evaluation of a Team Simulation Training Program.

Care of the trauma patient requires a well-coordinated intensive effort during the golden hour to optimize survival. We hypothesized that this program would improve knowledge, satisfaction, self-confidence, and simulated team performance. A pre-, post-test design with N = 7 BSN nurses, 21 years of age, less than 2 years of intensive care unit and nursing experience. Trauma intensive care unit, single-center academic Level 1 trauma center. Improvement was shown in perception of team structure (paired t test 13.71-12.57; p = .0001) and communication (paired t test 14.85-12.14; p = .009). Improvement was shown in observed situation monitoring (paired t test 17.42-25.28; p = .000), mutual support (paired t test 12.57-18.57; p = .000), and communication (paired t test 15.42-25.00; p = .001). A decrease was shown in attitudes of mutual support (paired t test 25.85-19.71; p = .04) and communication (paired t test 26.14-23.00; p = .001). Mean satisfaction scores were 21.5 of a possible 25 points. Mean self-confidence scores were 38.83 out of a possible 40 points. Simulation-based team training improved teamwork attitudes, perceptions, and performance. Team communication demonstrated significant improvement in 2 of the 3 instruments. Most participants agreed or strongly agreed that they were satisfied with simulation and had gained self-confidence.

PP.31.17

Objective: Blood pressure (BP) and heart rate (HR) follow a circadian rhythm. The aim of the study was to assess the BP and HR patterns in shift intensive care unit (ICU) nurses. Design and method: We enrolled 21 nurses working in an 8 hours shift schedule (morning: 07–15, afternoon: 15–23, night: 23–07) at a general ICU. Demographic and clinical data was obtained by completing a short questionnaire. The nurses were invited to measure their BP and HR at the beginning, in the middle and at the end of their shift. Collected information also included shift details (e.g. number of new admitted patients). An ESH certified automatic device was used for the BP and HR measurements. Results: The mean age of the nurses was 40,4 ± 5,0 years with a mean work experience of 14,2 ± 6,0 years (7,3 ± 5,3 years in ICU). In total, there were 560 BP and HR measurements in 246 shifts (97 shifts missing no measurement). The mean systolic BP, diastolic BP and HR were 112,1 ± 12,7 mmHg, 73,4 ± 8,8 mmHg and 81,7 ± 10,3 bpm. There was no difference in the mean levels of BP and HR in relation to the type of shift (Table 1a). Moreover no difference could be demonstrated when analysis was focused comparing the mean BP and HR levels in the beginning, in the middle and the end of the shift in each of the three types of shifts (Table 1b). Nevertheless, it was noticed that BP and HR levels were apparently not stable in each shift for every nurse, but could be rising or falling, with maximum variation observed in afternoon shift (Table 1c).Conclusions: The mean systolic and diastolic BP and HR levels of shift ICU nurses appear to be stable between the three types of shifts (morning, afternoon and night) irrespective of the measurement timing (start, middle, end of shift). On the contrary, the variation of BP and HR levels in each separate shift for every nurse is significant and maximized in the afternoon shift. It could be contemplated that BP and HR levels of ICU shift nurses do not follow a circadian pattern.

O-082 Epidemic Gradient Of Severe Bronchiolitis From Paris Region To East And West Of France. Retrospective Study

<h3></h3> In France, 2000 to 4000 infants are admitted each year in intensive care units for bronchiolitis, leading to a temporary increase of the activity. Anticipating this epidemic would greatly improve health care organisation in those units. Following a clinical observation, this study aimed to highlight a delay in the epidemic in the East of France compared to the West and a similarity in the severity of each epidemic. Retrospectively were included all the infants with a clinical and severe bronchiolitis hospitalised in intensive care units in the Brest, Kremlin-Bicêtre (KB) and Strasbourg university hospitals, one year in two from 2006 to 2013, between July, 1st and and June, 30th. 434 infants were included: 43 in Brest, 291 in KB and 100 in Strasbourg. Populations were comparable in terms of birth’s weight, term, history, sex-ratio, age, RSV rate, complication rate and death. Ventilation was longer in Strasbourg. The severity of epidemics was comparable during each period with a an admission ratio compared to KB of 15%* in Brest and 34%* in Strasbourg (*p &lt; 0,05). Epidemic occurred with a delay of 2 to 5 weeks in Strasbourg, and 2 to 7 weeks in Brest. The severe cases of bronchiolitis appear several weeks earlier in KB than in Strasbourg and Brest, with a comparable severity every year in these three regions. The observation of the situation in KB allows for anticipating the severity and date of the epidemic in Brest and Strasbourg.

Antibiotic consumption and resistance: Data from Europe and Germany

The use of antibiotics – including the over- and misuse – in human and veterinary practices selected for resistant pathogens and led to their emergence and dissemination along with the transmission of resistant bacteria. The aim of this article is to prescribe the prerequisites for the surveillance of antibiotic use and bacterial resistance, to explain advantage and disadvantage of surveillance parameters used, to present new data from a surveillance network of intensive care units focusing on antibiotic use and resistance and to discuss the impact of antibiotic use on resistance.The Surveillance System of Antibiotic Use and Bacterial Resistance in Intensive Care Units (SARI) is an on-going project that collects data from its network of intensive care units (ICU) in Germany. Antimicrobial use was expressed as daily defined doses (DDD) and normalized per 1000 patient-days (pd). ICU decided either to provide monthly data on antibiotic and resistant pathogens or they decided to provide only yearly data on antibiotic use without resistance data.85% of all antibiotics used in Germany are administered in animals; 85% of the antibiotics used in humans are prescribed in the outpatient setting and 85% of the antibiotics used in hospitals are prescribed on non-ICUs wards. The mostly widely used parameter for the surveillance of resistance is the percentage of resistant pathogens which is important to guide empirical therapy but does not measure the burden of resistance which is of interest to the public health perspective. The burden of MRSA did not increase over the last 11 years in ICUs and was 4.2MRSA/1000pd in 2011. The burden of 3rd generation resistant E. coli and K. pneumoniae more than quintupled (up to 2.6 and 1.2 respectively) and was followed by a three times increased use of carbapenems and correlated with quinolone and 3rd generation cephalosporin use. The burden VRE faecium also increased dramatically from 0.1 to 0.8 within 11 years; VRE faecium showed no significant correlation to vancomycin use (p=0.190) although glycopeptide use increased lately.Antibiotic use in animals and humans correlates with the risk of resistant microorganisms in a multifactor and complex way; it is of upmost importance that surveillance and interventions focus on all sectors: animal use and in- and outpatient setting in humans.

Peripheral venous blood gas analysis: An alternative to arterial blood gas analysis for initial assessment and resuscitation in emergency and intensive care unit patients.

Arterial blood gas (ABG) analysis is the gold standard method for assessment of oxygenation and acid base analysis, yielding valuable information about a variety of disease process. This study is aimed to determine the extent of correlation between arterial and peripheral venous samples for blood gases and acid base status in critically ill and emergency department patients and to evaluate if venous sample may be a better alternative for initial assessment and resuscitation. The prospective study was conducted on 45 patients of either sex in the age group of 15-80 years of intensive care unit and emergency ward. Relevant history, presenting complaints, vital signs, and indication for testing were recorded. Arterial and peripheral venous samples were drawn simultaneously in a pre-heparinized syringe and analyzed immediately for blood gases and acid base status. Mean difference and Pearson's product moment correlation coefficient was used to compare the result. After statistical evaluation, the present study shows minimal mean difference and good correlation (r > 0.9) between arterial and peripheral venous sample for blood gases and acid base status. Correlation in PO2 measurement was poor (r < 0.3). Thus, venous blood may be a useful alternative to arterial blood during blood gas analysis obviating the need for arterial puncture in difficult clinical situation especially trauma patients, for initial emergency department assessment and early stages of resuscitation.