Intensive/Critical care - overview
(SEE ALSO - Mechanical ventilation)
WEBSITE for ex-ICU patients:
www.icusteps.com/index.php
GUIDELINES on LEVELS OF CRITICAL CARE
www.ics.ac.uk/intensive_care_professional/standards_and_guidelines/levels_of_critical_care_for_adult_patients
GUIDELINES on the ACUTELY ILL PATIENT
www.nice.org.uk/nicemedia/live/11810/35950/35950.pdf
Akhtar S (2000) Use of active noise cancellation devices in caregivers in the ICU. Crit Care Med, 28, 4, 1157-60
Azoulay E (2005) Risk of posttraumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med, 171, 987-94
ajrccm.atsjournals.org/cgi/content/abstract/171/9/987?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&searchid=1139732928382_115&FIRSTINDEX=0&volume=171&firstpage=987&journalcode=ajrccm (abstract only)
symptoms of post-traumatic stress disorder found in a third of family members of ICU patients
Azoulay E (2002) Impact of a family information leaflet on effectiveness of information provided to family members of ICU patients. Am J Respir Crit Care Med, 165, 438-42
ajrccm.atsjournals.org/cgi/content/abstract/165/4/438
beneficial effects of information booklet.
Bδckman CG (2001) Use of a personal diary written on the ICU during critical illness. Int Care Med, 27, 426-9
springerlink.metapress.com/app/home/contribution.asp?wasp=20db5eea66be4bc1b7d8c974199bbc93&referrer=parent&backto=issue,14,29;journal,60,127;browsepublicationsresults,951,2445;
Binnekade JM (2006) The reliability and validity of a new and simple method to measure sedation levels in intensive care patients. Heart Lung, 35, 2, 137-43
sedation scale which reduces over-sedation and simplifies assessment in the ICU.
BMJ editorial (2003) Immunonutrition. BMJ, 327,117-18
bmj.bmjjournals.com/cgi/content/full/327/7407/117
specific nutrients for surgical patients boost the immune system, and for critically ill patients modulate the early hyperinflammatory response and the overcompensating immunosuppression
Boldt J (2000) Volume therapy in the intensive care unit. Int Care Med, 26, 1181-92
you can now keep up with ward round discussions on crystalloids and colloids
Bochicchio GV (2005) Persistent hyperglycemia is predictive of outcome in critically ill trauma patients. J Trauma-Injury Inf Crit Care, 58, 921-4
www.jtrauma.com/pt/re/jtrauma/abstract.00005373-200505000-00008.htm;jsessionid=CO5EKlmYRMKPcbJGGy72sAD2B6RZWJFeF315LiHLGi1QDiEb20Jw!1707623050!-949856031!9001!-1
aggressive hyperglycemic control is required in trauma patients: persistent hyperglycemia increases morbidity and mortality.
Bruton A, Conway JH, Holgate ST (2002) Inspiratory muscle dysfunction after prolonged periods of mechanical ventilation. Physiother, 88, 131-7
Carr J (2007) Psychological consequences associated with intensive care treatment. Trauma, 9, 95102
problems include cognitive impairment, depression, hopelessness, anxiety, and PTSD
stressors include tubes in nose and mouth, pain, sleep disturbance, thirst, noise, not being in control, inability to communicate and lack of information
all patients showed cognitive impairment; all ARDS patients showed cognitive impairment at discharge and 30% showed it after 1 year; 32% of medical ICU patients showed cognitive impairment at 6/12 follow-up; 57% of trauma survivors showed cognitive impairment at 12 years follow-up.
22 - 83% of ICU patients experience delirium, with higher rates for those receiving IPPV
30% of patients suffered clinically significant depression, 43% significant anxiety
27.5- 43.5% of patients suffered from PTSD, with 23.9% having PTSD at 8 year follow-up, length of stay being predictive of this
33-40% of patients dont recall their ICU stay; delusions more frequent in those who couldnt recall their ICU stay or who had developed an infection; factual recall of the ICU may be protective against psychological difficulties.
51% of patients report nightmares during ICU and 14% are still disturbed by these 6/12 post-discharge
A self-help manual reduces depression
Recommendations - prevent dehydration, sleep disturbance and hypoxaemia, providing cognitive stimulation, specs, hearing aids, and early mobilisation
Carter CA (2008) From ICU top outreach. Southern African J Crit Care, 24, 2, 50-55
ajol.info/index.php/sajcc/article/view/35549
introduction of MEWS and outreach improves the care of patients by sharing ICU knowledge and skills.
Chanques G (2006) Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med, 34, 6, 1691-9
www.ccmjournal.com/pt/re/ccm/abstract.00003246-200606000-00017.htm;jsessionid=Fx5S0802TvGVkfdL4QM2YpnVygQgp4pJ2V3HmwQDmVmZrdf7QLl2!1299987372!-949856145!8091!-1
systematic evaluation of pain and agitation was associated with reduced duration of mechanical ventilation and nosocomial infections
Ciccarello GP (2003) Strategies to improve end-of-life care in the intensive care unit. Dim.Crit.Care Nurs, 22, 216-22
www.nursingcenter.com/library/JournalArticle.asp?Article_ID=424146
Cuthbertson BH et al (2007) Can physiological variables and early warning scoring systems allow early recognition of the deteriorating surgical patient? Crit Care Med, 35, 402-9
www.ncbi.nlm.nih.gov/pubmed/17205002?dopt=AbstractPlus&holding=f1000,f1000m,isrctn
most systems have good discriminatory power
Cuthbertson BH, Hull AM (2007) Psychological consequences of critical illness: aftercare or afterthought? Br J Hosp Med, 68, 474-6
www.bjhm.co.uk/cgi-bin/go.pl/library/abstract.html?uid=27166
Cuthbertson BH, Hull AM (2007) A pragmatic randomized controlled trial of intensive care follow up programmes in improving longer-term outcomes. BMC Health Serv Res, 7, 116
www.biomedcentral.com/1472-6963/7/116
Cuthbertson BH (2008) Life after intensive care. Crit Care Med, 36, 1668-9
Dewar AL (1995) Unbearable incidents: failure to endure the experience of illness. J.Adv.Nurs, 22, 957-64
Docherty B (2003) Cardiac care: interpretation of ECG. Prof Nurse, 18, 322-32
Dorisanne D (2003) Aerosol delivery and modern mechanical ventilation Am J Respir Crit Care Med, 168, 1205-9
ajrccm.atsjournals.org/cgi/content/full/168/10/1205
aerosol delivery in ventilated patients must have tightly-controlled ventilator parameters
Dubois M-J (2001) Delirium in an ICU. Int Care Med, 27, 1297-1304
springerlink.metapress.com/app/home/contribution.asp?wasp=32a95183cc064cf5a2fe84917551307f&referrer=parent&backto=issue,10,39;journal,54,127;browsepublicationsresults,951,2443
delirium is associated with increased morbidity and can be identified early
Ely EW et al (2001) Delirium in mechanically ventilated patients: validity and reliability of the Confusion Assessment Method for the ICU. J Am Med Ass, 286, 21, 2703-10
Finkielman JD (2004) Underweight is independently associated with mortality in patients admitted to the intensive care unit. BMC Emerg.Med, 4, 3
www.biomedcentral.com/1471-227X/4/3/abstract
Fletcher SJ, Cuthbertson BH (2010) Outreach, epistemology and the evolution of critical care. Anaesthesia, 65, 2, 115-118
www3.interscience.wiley.com.ezproxy.brighton.ac.uk/cgi-bin/fulltext/123221310/HTMLSTART
choosing who to admit to ICU should be based on whose survival depends on ICU intervention, not based on predictions of death (this admission criteria may explain why outreach has not yet shown efficacy)
Gao H, Harrison DA, Parry GJ, Daly K, Subbe CP, Rowan K (2007) The impact of the introduction of critical care outreach services in England. Crit Care, 11, R113
ccforum.com/content/11/5/R113
there is no clear evidence that critical care outreach has had a significant impact on patient outcome, nor evidence for the characteristics of what should form the optimal outreach system.
Gonzalez CE (2004) Visiting preferences of patients in the ICU and in a complex care medical unit. Am J Crit Care, 13, 194-8
ajcc.aacnjournals.org/cgi/content/abstract/13/3/194?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Gonzalez+CE+&andorexactfulltext=and&searchid=1122376132069_71&stored_search=&FIRSTINDEX=0&sortspec=relevance&firstpage=194&resourcetype=1&journalcode=a
patients vary in their preferences for visiting, e.g. unlimited, once a day, not early or late
Granja C (2005) Patients' recollections of experiences in the intensive care unit may affect their quality of life. Crit Care, 9, R96-R109
Griffiths RD, Jones C (1999) Recovery from intensive care. BMJ, 319, 427-9 bmj.bmjjournals.com/cgi/content/full/319/7207/427?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1097408456011_2694&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=319&firstpage=427&resourcetype=1
Griffiths RD et al (2001) Filllng the intensive care memory gap? Int Care Med, 27, 344-6
interesting editorial on prevention of delusional memories in ICU patients
Griffiths MJD, Evans TW (2002) The pulmonary physician in critical care. Thorax, 57, 77-8
classification of ICU patients according to dependency rather than location.
Hansen-Flaschen JH (2000) Dyspnea in the ventilated patient. Respir Care, 45, 1460-4
www.rcjournal.com/contents/12.00/12.00.1460.asp
measurement of, and management of, SOB in the ventilated patient
Happ MB (2004) Electronic voice-output communication aids for temporarily nonspeaking patients in a medical intensive care unit: a feasibility study. Heart Lung, 33, 2, 92-101
lack of communication for intubated people causes fear and sleeplessness, but electronic voice is possible with selected patients.
Hopkins RO, Jackson JC (2009) Short- and long-term cognitive outcomes in intensive care unit survivors. Clin Chest Med, 30, 1, 143-153
Hwang CH, Choi KH, Ko YS, Leem CM (2007) Pre-emptive swallowing stimulation in long-term intubated patients. Clinical Rehabilitation, 21, 41-46.
neck and jaw exercises may help prevent throat damage resulting from intubation
Hudson LD (2003). Neuromuscular sequelae of critical illness. N Engl J Med, 348, 745-7
content.nejm.org/cgi/content/extract/348/8/745?andorexacttitleabs=and&search_tab=authors&tmonth=Jul&searchtitle=Authors&sortspec=Score+desc+PUBDATE_SORTDATE+desc&excludeflag=TWEEK_element&hits=20&tyear=2005&author1=Hudson+LD+&andorexactfulltext=and&fyear=1995&fmonth=Jul&sendit=GO&searchid=1122376891690_1420&FIRSTINDEX=0&journalcode=nejm
Jablonski RS (1994) The experience of being mechanically ventilated. Qual Health Res. 4, 186-207
essential reading for all involved with ICU patients
Jeejeebhoy KN (2004) Permissive underfeeding of the critically ill patient. Nutrition Clin Practice, 19, 5, 477-80
ncp.aspenjournals.org/cgi/content/abstract/19/5/477
only burns patients need hyper-alimentation; excess glucose increases carbon dioxide production; hyperglycemia increases risk of infective complications
Jennings A, Norman A, Whitelock D (2010) Elective peri-operative intra-aortic balloon counterpulsation during maxillofacial free flap reconstructive surgery in a patient with severe cardiomyopathy. Anaesthesia, 65, 2, 204-6
Jones C, Griffiths R (2006) Long-term outcome from critical illness. Anaesth Int Care Med, 7, 155-156
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B8CXB-4M9S193-5&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=7c5025852c6c4518e40c929df5184fc9
physical recovery may take over a year
Karlsson V, Forsberg A (2008) Health is yearning experiences of being conscious during ventilator treatment in a critical care unit. Int Crit Care Nurs, 24, 1, 41-50Kreimeier U (2000) Pathophysiology of fluid imbalance. Crit.Care, 4(Suppl 2):S3-S7
ccforum.com/content/4/S2/S3
Lawrence M (1995) The unconscious experience. Am.J.Crit.Care, 4, 227-32.
ajcc.aacnjournals.org/cgi/content/abstract/4/3/227
patients recollections of how much they remember when unconscious
Leach RM, Treacher DF (2002) The pulmonary physician in critical care: oxygen delivery and consumption in the critically ill. Thorax, 57, 170-7
thorax.bmjjournals.com/cgi/content/full/57/2/170?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Leach+RM&andorexactfulltext=and&searchid=1122377189371_638&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=57&firstpage=170&resourcetype=1&journalco
how to disentangle all those oxygen delivery/consumption knots
Levy MM et al (2008) Association between critical care physician management and patient mortality in the ICU. Ann Int Med, 148, 801-8
www.annals.org/content/148/11/801.full.pdf+html
patients in ICUs staffed by non-ICU physicians were subject to less procedures and showed lower mortality that those staffed by ICU specialists.
Lilly CM (2007) The healing power of listening in the ICU. New Eng J Med, 356, 513-15
content.nejm.org/cgi/content/short/356/5/513?query=TOC
Lφf L et al (2006) Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay 3 and 12 months after discharge. Int Crit Care Nurs, 22, 154-66
memories are traumatic, fragmentary and associated with intense fear.
Meltzer LS (2004) Critical care nurses perceptions of futile care and its effect on burnout. Am J Crit Care, 13, 202-8
ajcc.aacnjournals.org/cgi/content/abstract/13/3/202?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Meltzer+LS&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1122376245095_76&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=13&firstpage=202&journalcode=ajcc
one study found 50% of nurses, 30% physicians and 70% of house staff had treated patients against their conscience
Parthasarathy S, Tobin MJ (2004) Sleep in the intensive care unit. Int Care Med, 30, 197 - 206
sleep fragmentation contributes to raised BP, is worse than for patients with sleep apnoea, and is due to noise, procedures, IPPV,
Payen JF et al (2001) Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med, 29, 2258-63
www.ccmjournal.com/pt/re/ccm/abstract.00003246-200112000-00004.htm;jsessionid=Fy2CGhDdbhGDZch8tG4mTdGSkWljhjgvQzQqpDZc5yNQKPc17xKw!1299987372!-949856145!8091!-1
pain can be scored validly and reliably in sedated, mechanically ventilated patient
Peek GJ, Mugford M, Tiruvoipati R et al (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure. Lancet, 374, 135163.
RCT of 180 patients reported death or severe disability in 37% of those randomised to consideration for treatment by ECMO and 53% of those treated conventionally
Robinson LE, van Soeren MH (2004) Insulin resistance and hyperglycemia in critical illness, AACN Clinical Issues, 15, 45-62
www.aacnclinicalissues.com/pt/re/aacn/abstract.00044067-200401000-00004.htm;jsessionid=CmkCgfaN5EV4EZuPeqKvmR3SjC612WJSjKItxez7sGtkcNUlTTqw!-2006515172!-949856031!9001!-1
endocrine response to prolonged critical illness can upset glucose metabolism
control of hyperglycemia has shown reduced morbidity and mortality
Rotondi AJ et al (2002) Patients recollections of stressful experiences while receiving prolonged mechanical ventilation. Crit Care Med, 30, 746-52
www.ccmjournal.com/pt/re/ccm/abstract.00003246-200204000-00004.htm;jsessionid=CmlhVvP3xOQF7EGpxnNc9QdSRSBaRt1mRmbjZHkiVxSK0nuK2hAm!654213914!-949856032!9001!-1
Roussos M (2010) Can we improve sleep quality by changing the way we ventilate patients? Lung, 188, 1, 1
resources.metapress.com/pdf-preview.axd?code=r4417537k5256272&size=largest
sleep deprivation increases risk of impaired respiratory, cognitive, cardiovascular, endocrine and immune function, and (in women) diabetes
Rundshagen I (2002) Incidence of recall, nightmares, and hallucinations during analgosedation in intensive care. Int Care Med, 28, 38-43
springerlink.metapress.com/app/home/contribution.asp?wasp=32a95183cc064cf5a2fe84917551307f&referrer=parent&backto=issue,4,18;journal,46,127;browsepublicationsresults,951,2443
ICU patients report a high incidence of recall of unpleasant events and a vivid memory for nightmares and hallucinations
Schnyder U (2000) Early psychological reactions to life-threatening injuries. Crit Care Med, 28, 86-92
www.ccmjournal.com/pt/re/ccm/abstract.00003246-200001000-00014.htm;jsessionid=CmlhVvP3xOQF7EGpxnNc9QdSRSBaRt1mRmbjZHkiVxSK0nuK2hAm!654213914!-949856032!9001!-1
Scragg P (2001) Psychological problems following ICU treatment. Anaesthesia, 56, 9-14
www.blackwell-synergy.com/doi/abs/10.1046/j.1365-2044.2001.01714.x
27.5% incidence of post-traumatic stress disorder found in post-ICU patients
Silversides JA, Quinn LD, Parker MJ (2010) Is the cause of hypernatraemia in critically ill patients more obvious than we think? Anaesthesia, 65, 1, 87-88
high sodium levels are an independent risk factor for mortality and are mostly iatrogenic, i.e. related to intravenous fluid and drugs
Spector N, Klein D (2001) Chronic critically ill dyspneic patients: mechanisms and clinical measurement. AACN Clin Issues, 12, 220-33
www.aacnclinicalissues.com/pt/re/aacn/abstract.00044067-200105000-00006.htm;jsessionid=L5ccnPxLRnqdHsQ9QZbdngv8knm3ftz4GZ2VCB1876Vlsf6m9vGP!62360543!181195629!8091!-1
Lowson S (2004) Alternatives to nitric oxide. Br Med Bull, 70, 119-31
bmb.oxfordjournals.org/cgi/content/abstract/70/1/119?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Lowson+S&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1122364624070_2&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=70&firstpage=119&journalcode=bmbull
alternatives such as prostacycline to reduce pulmonary hypertension
Tamburri LM (2004) Nocturnal care interactions with patients in critical care units. Am J Crit Care, 13, 102-15
ajcc.aacnjournals.org/cgi/content/abstract/13/2/102?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Tamburri+LM&andorexactfulltext=and&searchid=1122364795520_8&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=13&firstpage=102&resourcetype=1&journalcode=ajcc
patient interactions at night leave little time for sleep
clustering of nocturnal activities is recommended
Townsend P, Webster NR (2000) Why is the patient still hypoxic despite being ventilated? J Roy Coll Surg Edinburgh, 45, 235-40
www.rcsed.ac.uk/journal/vol45%5F4/4540026.htm
excellent explanation of the oxygen cascade, oxygen delivery, oxygen stores
Trappe H-B (2003) Arrhythmias in the intensive care patient Curr.Opin.Crit.Care, 9, 345-55
www.co-criticalcare.com/pt/re/cocritcare/abstract.00075198-200310000-00003.htm;jsessionid=CmExYrYS8Mvc9U25G6Dz1oElvMR1MsdyuPI16z1IzhIkY8rsqCaB!-2006515172!-949856031!9001!-
1?index=1&results=1&count=10&searchid=1&nav=search&database=lwwovft
Treggiari MM, Karir V, Yanez ND (2008) Intensive insulin therapy and mortality in critically ill patients. Crit Care, 12, R29
ccforum.com/content/12/1/R29/abstract
insulin therapy with tight glycaemic control reduces mortality and morbidity in post-cardiac surgery patients, but is not yet proven for all ICU patients.
Trivedi M (2001) Intermediate outcome of medical patients after intensive care. Anaesthesia, 56, 841-6
www.blackwell-synergy.com/doi/abs/10.1046/j.1365-2044.2001.02174.x?prevSearch=allfield%3A%28Intermediate+outcome+of+medical+patients+after+intensive+care%29
patient-at-risk teams
management of post-ICU complications
Van Rompaey B (2008) A comparison of the CAM-ICU and the NEECHAM Confusion Scale in intensive care delirium assessment: an observational study in non-intubated patients. Crit Care, 12, R16
ccforum.com/content/12/1/R16/abstract
Van Kaam, AHLC, Lutter R, Lachmann RA et al (2005) Effect of ventilation strategy and surfactant on inflammation in experimental pneumonia. Eur Respir J, 26, 112-117
erj.ersjournals.com/cgi/content/abstract/26/1/106
early gastrostomy is associated with a lower frequency of ventilator-associated pneumonia compared to nasogastric tube
Vazirani S, Hays RD, Shapiro MF, Cowan M (2005) Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care,14, 71-7
ajcc.aacnjournals.org/cgi/content/abstract/14/1/71?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Vazirani+S&andorexactfulltext=and&searchid=1122364902722_12&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=14&firstpage=71&resourcetype=1&journalcode=ajcc
daily multidisciplinary rounds lead to improved communication and collaboration among staff
Williams TA, Knuiman MW, Finn JC (2010) Effect of an episode of critical illness on subsequent hospitalisation. Anaesthesia, 65, 2, 172-7
importance of early identification of risk factors at ICU discharge
Zimmermann M et al (2009) Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study. Crit Care, 13, 1, R10.
ICU = intensive care unit
IPPV = intermittent positive pressure ventilation