scholarly journals West Nile Virus Infection in the Intensive Care Unit: A Case Series and Literature Review

2004 ◽  
Vol 11 (5) ◽  
pp. 354-358 ◽  
Author(s):  
Eddy Fan ◽  
Dale M Needham ◽  
James Brunton ◽  
Ralph Z Kern ◽  
Thomas E Stewart
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
West Nile Virus ◽  
Tertiary Care ◽  
Case Series ◽  
Flaccid Paralysis ◽  
West Nile ◽  
Metabolic Encephalopathy ◽  
Critical Care Issues

BACKGROUND:West Nile virus (WNV) is a rapidly spreading infectious disease in North America. Critical care issues related to WNV are not well described.OBJECTIVES:Three cases of severe WNV meningoencephalitis with flaccid paralysis are reported and relevant critical care issues are highlighted.METHODS:Case series and a review of the literature.RESULTS:Three patients with WNV meningoencephalitis and flaccid paralysis were admitted to the authors' academic, tertiary-care intensive care unit (ICU) in the late summer of 2002. All three patients were middle-aged or elderly and presented with a febrile illness that preceded or coincided with their neurological symptoms. Confirmation of WNV infection was problematic because each patient had at least one initial negative serum serology test. Radiological testing yielded nonspecific results. Serial electroencephalograms were consistent with severe toxic metabolic encephalopathy in all cases. All patients had a severe, diffuse axonal polyneuropathy demonstrated by nerve conduction studies and electromyography. Prolonged mechanical ventilation resulted in ICU lengths of stay of 44 to 118 days. At one point, 21% of the ICU beds were dedicated for these patients. All three patients died in hospital -- two following the withdrawal of life support. One patient demonstrated resolving encephalitis and was discharged from the ICU after a 118-day ICU stay, but later died in a step-down unit.CONCLUSIONS:The management of WNV-related critical illness creates challenges in making a timely and accurate diagnosis, and predicting patient morbidity and mortality. As a consequence, end-of-life discussions with families are especially difficult. The prolonged ICU length of stay and growing incidence of this disease may challenge limited critical care resources.

scholarly journals Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000239 ◽  
Author(s):  
Krishna Aparanji ◽  
Shreedhar Kulkarni ◽  
Megan Metzke ◽  
Yvonne Schmudde ◽  
Peter White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Quality Metric ◽  
Risk Of Mortality ◽  
Simulation Based ◽  
Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

Mortality Review of Children Admitted in Pediatric Intensive Care Unit Over One Year in a Tertiary Care Hospital

2021 ◽  
Vol 6 (1) ◽  
pp. 1369-1372
Author(s):  
Pun Narayan Shrestha ◽  
Sumit Agrawal ◽  
Kosh Raj R C ◽  
Prakash Joshi ◽  
Ajit Rayamajhi
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Congenital Heart ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Care Hospital ◽  
Female Ratio

Introduction: Childhood mortality is still high in developing countries. This can be reduced with good preventive and curative services especially with critical care. The treatment of critically ill children must be focused for better outcome. The pediatrics deaths audit and review provide feedback to health workers and to the institution. The outcome measures of critical care medicine include mortality, morbidity and disability rate. Objectives: The aim of this study is to review the causes and mode of death in children and length of PICU (pediatric intensive care unit) stay. Methodology: A retrospective study was conducted of the patients who were admitted and died within the period of 16 July 2019 to 15 July, 2020 at PICU of Kanti Children Hospital (KCH). Variables recorded were patient's demography, diagnosis, co- morbidities, complications, length of PICU stay (LOS), mode and time of death. Data were tabulated into MS Excel and analyzed using SPSS version 23. Result: Out of 718 admitted children, 99 (13.78%) died with male to female ratio of 1.8:1. The maximum death (75%) was observed in less than five year of age and most of them were from outside the Kathmandu valley. The leading causes of death were pneumonia (28%), sepsis (20%) and congenital heart diseases (21%). The common complications seen were disseminated intravascular coagulation (DIC), multi- organ dysfunction syndrome (MODS), acute kidney injury (AKI) (5.1 %) and acute respiratory distress syndrome (ARDS) (6.1%) and co- morbidities were congenital heart disease (CHD) (18.2%) and global developmental delay (GDD) (9.1%). Mechanical ventilation was needed in 80.8%. Most of the cases (86%) died despite active treatment and (75%) during off hours (4pm-9am). Conclusion: Pneumonia, sepsis and CHD were the main reason of death and most of them were from outside the valley. 

Transesophageal Echocardiography

2019 ◽  
pp. 816-826
Author(s):  
Ryan C. Craner ◽  
Farouk Mookadam ◽  
Harish Ramakrishna
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
North America ◽  
Transesophageal Echocardiography ◽  
Transthoracic Echocardiography ◽  
Tertiary Care ◽  
Specialized Training ◽  
Critical Care Echocardiography ◽  
Tertiary Care Centers

The use of ultrasound has revolutionized care in the intensive care unit (ICU). The use of critical care echocardiography, including transthoracic echocardiography (TTE), has become commonplace in ICUs worldwide. In North America, however, intensivists rarely perform transesophageal echocardiography (TEE) unless they have anesthesiology training or have received specialized training to be competent in TEE. In many centers, neurology critical care is provided within the general ICU, and many tertiary-care centers have a dedicated ICU for specialized cases that require advanced and intensive neurologic care.

Etiology of Fever and Opportunities for Reduction of Antibiotic Use in a Pediatric Intensive Care Unit

2001 ◽  
Vol 22 (08) ◽  
pp. 499-504 ◽  
Author(s):  
Philip Toltzis ◽  
Bonnie Rosolowski ◽  
Ann Salvator
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
Critically Ill Children ◽  
Axillary Temperature ◽  
Prospective Case Series

Abstract Objective: To determine the cause of fever in critically ill children and to identify opportunities for reducing antibiotic use in this population. Design: Prospective case series. Setting: A tertiary-care medical-surgical pediatric intensive care unit (PICU). Patients: Children admitted to the PICU who experienced fever (axillary temperature &gt;38.3°C). Measurements: Consecutive children who were febrile at any point in their PICU stay were investigated over two winter seasons. Etiology of the fever was determined by physical examination and routine microbiology and radiographic tests. Three subgroups were reviewed to approximate the number of antibiotic-days that could have been reduced; namely, those with an indeterminate source, those with a documented viral infection, and those receiving a prolonged course of antibiotics. A set of standards reflecting common antibiotic use then was applied to these three patient groups. Results: Of 211 subjects, the majority (83.3%) had either a definitive or suspected focus for their fever, and nearly all of these patients were judged to have an infectious etiology. The study population received a total of 2,036 antibiotic-days. Despite the high incidence of infectious causes of fever in our subjects, however, approximately 15% of total antibiotic-days could have been reduced by applying common-use standards. Conclusions: Fever in the PICU was usually of defined focus and infectious in origin. However, among febrile patients in the PICU, substantial opportunity exists for reduction of antibiotic use. Trials determining the safety of antibiotic reduction in this population should be pursued vigorously.

scholarly journals Cost analysis of critical patient care at a pediatric intensive care unit of a tertiary care public hospital in an urban metropolis of India

2021 ◽  
Vol 10 (7) ◽  
pp. 834
Author(s):  
Renuka P. Munshi ◽  
Alisha Dhiman ◽  
Sushma U. Save
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Care ◽  
Public Hospital ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Allocation Of Resources ◽  
Bed Days ◽  
The Cost

Background: The cost of critical care is widely recognized as being high. However, it remains a challenge to accurately assess the cost of intensive care due to a lack of standardized methodology. There is also considerable heterogeneity with regard to allocation of resources and distribution of critical care services.Methods: We conducted a prospective study to analyse diagnosis-based costs of paediatric patient care at a pediatric intensive care unit (PICU) in a public hospital in Mumbai on the basis of identified cost components; direct (fixed and variable) and indirect costs.Results: Out of 167 (102 boys, 61%) patients enrolled, 65 (39%) were aged 1-7 months. They spent an average of 4±1.46 bed days in the PICU. The cost of direct fixed components (salaries, capital equipment, disposables) was Rs. 64,48,200 for six months. The maximum cost of direct variable components spent by the hospital (physiotherapy intervention, expert opinion, investigations, medicines, blood products, piped gases) amounted to Rs. 548.63/patient/day for treatment of non-infectious diseases. Cost of indirect components (building maintenance) was Rs. 12,500/six months. Linear regression analysis showed 83-99.99% dependency of treatment cost to diagnosis and bed days. The average cost of treatment of infectious and non-infectious diagnoses/patient/day spent by the hospital was Rs. 260 and Rs. 548.63 respectively as compared to Rs. 169.96 and Rs. 356.21 spent by the patients.Conclusions: Our study showed that majority of the treatment costs depended on the diagnosis and number of bed days of the patients. Also being a tertiary care public hospital, 60% of the treatment costs were borne by the hospital. Thus, our study attempts to quantify, in financial terms, the expenditure involved in running a paediatric ICU in a tertiary care public hospital so as to assist doctors and healthcare decision makers in the allocation of resources.

scholarly journals Mucormycosis: A Case Series of Patients admitted in Non-COVID-19 Intensive Care Unit of a Tertiary Care Center during the Second Wave

2021 ◽  
Vol 25 (10) ◽  
pp. 1191-1194
Author(s):  
Nikhil Kothari ◽  
Amit Goyal ◽  
Ankur Sharma ◽  
Shilpa Goyal ◽  
Pradeep K Bhatia ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Tertiary Care Center ◽  
Second Wave

scholarly journals Frequency of foreign body inhalation in eight month duration admitted in Paediatric intensive care unit of Abbasi Shaheed hospital (tertiary care centre)

2017 ◽  
Vol 1 (1) ◽  
pp. 31
Author(s):  
Ashfar Alam Mallick
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Foreign Body ◽  
Respiratory Distress ◽  
Tertiary Care ◽  
Case Series ◽  
Betel Nut ◽  
Rapid Improvement ◽  
Tertiary Care Centre ◽  
Foreign Body Inhalation

We present four cases of foreign body inhalation in eight month period (May-Dec 2016) admitted in pediatric intensive care unit (p.i.c.u) of Abassi Shaheed Hospital. Age range was eleven months to four years. Male gender was predominant among the case series. All of the cases presented with sudden onset of respiratory distress along with fever and cough. On examination all patients were febrile, tachpneic, tachycardic with subcostal and intercostal recessions. A working diagnosis of severe pneumonia was made and child was put on intravenous antibiotics and nebulizations. After 48 hours of admission, there was no improvement clinically so suspicion of foreign body was made on the basis chest of x-ray. Rigid bronchoscopy was done; foreign body peanut (1), chicken bone (1) and betel nut (2) were found. All children showed rapid improvement after removal of foreign body and were discharged soon after. Parents were counseled regarding addiction of betel nut and avoidance of foreign body   inhalation in growing children. Hence we conclude that foreign body inhalation should be kept as a differential diagnosis in every child presenting with respiratory distress without improvement despite treatment. Parents should also be counseled for being vigilant around their children. There is no conflict of interest.

CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Acid-base Disturbances in the Intensive Care Unit: Metabolic Acidosis

2006 ◽  
Vol 19 (6) ◽  
pp. 492-495 ◽  
Author(s):  
Anton C. Schoolwerth ◽  
Thomas M. Kaneko ◽  
Martin Sedlacek ◽  
Clay A. Block ◽  
Brian D. Remillard
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Acid Base ◽  
Critical Care Issues
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