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EMERGENCY AND INTENSIVE CRITICAL CARE (121 journals)                     

Showing 1 - 124 of 124 Journals sorted alphabetically
AACN Advanced Critical Care     Full-text available via subscription   (Followers: 36)
Academic Emergency Medicine     Hybrid Journal   (Followers: 90)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acute and Critical Care     Open Access   (Followers: 9)
Acute Cardiac Care     Hybrid Journal   (Followers: 11)
Acute Medicine     Full-text available via subscription   (Followers: 8)
Advances in Emergency Medicine     Open Access   (Followers: 16)
Advances in Neonatal Care     Hybrid Journal   (Followers: 43)
African Journal of Anaesthesia and Intensive Care     Full-text available via subscription   (Followers: 7)
African Journal of Emergency Medicine     Open Access   (Followers: 7)
AINS - Anasthesiologie - Intensivmedizin - Notfallmedizin - Schmerztherapie     Hybrid Journal   (Followers: 5)
American Journal of Emergency Medicine     Hybrid Journal   (Followers: 54)
Annals of Emergency Medicine     Hybrid Journal   (Followers: 126)
Annals of Intensive Care     Open Access   (Followers: 37)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 15)
Archives of Academic Emergency Medicine     Open Access   (Followers: 6)
Archives of Trauma Research     Open Access   (Followers: 4)
ASAIO Journal     Hybrid Journal   (Followers: 2)
Australasian Journal of Paramedicine     Open Access   (Followers: 7)
Australian Critical Care     Full-text available via subscription   (Followers: 21)
Bangladesh Critical Care Journal     Open Access   (Followers: 1)
BMC Emergency Medicine     Open Access   (Followers: 25)
BMJ Quality & Safety     Hybrid Journal   (Followers: 65)
Burns Open     Open Access  
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 2)
Case Reports in Acute Medicine     Open Access   (Followers: 3)
Case Reports in Critical Care     Open Access   (Followers: 13)
Case Reports in Emergency Medicine     Open Access   (Followers: 19)
Chronic Wound Care Management and Research     Open Access   (Followers: 7)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32)
Clinical Intensive Care     Hybrid Journal   (Followers: 6)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 3)
Clinical Risk     Hybrid Journal   (Followers: 5)
Crisis: The Journal of Crisis Intervention and Suicide Prevention     Hybrid Journal   (Followers: 15)
Critical Care     Open Access   (Followers: 74)
Critical Care and Resuscitation     Full-text available via subscription   (Followers: 29)
Critical Care Clinics     Full-text available via subscription   (Followers: 34)
Critical Care Explorations     Open Access   (Followers: 3)
Critical Care Medicine     Hybrid Journal   (Followers: 279)
Critical Care Research and Practice     Open Access   (Followers: 13)
Current Emergency and Hospital Medicine Reports     Hybrid Journal   (Followers: 5)
Current Opinion in Critical Care     Hybrid Journal   (Followers: 73)
Disaster and Emergency Medicine Journal     Open Access   (Followers: 12)
Egyptian Journal of Critical Care Medicine     Open Access   (Followers: 2)
EMC - Urgenze     Full-text available via subscription  
Emergency Care Journal     Open Access   (Followers: 7)
Emergency Medicine (Medicina neotložnyh sostoânij)     Open Access  
Emergency Medicine Australasia     Hybrid Journal   (Followers: 17)
Emergency Medicine Clinics of North America     Full-text available via subscription   (Followers: 19)
Emergency Medicine International     Open Access   (Followers: 8)
Emergency Medicine Journal     Hybrid Journal   (Followers: 53)
Emergency Medicine News     Full-text available via subscription   (Followers: 7)
Emergency Nurse     Full-text available via subscription   (Followers: 17)
Enfermería Intensiva (English ed.)     Full-text available via subscription  
European Burn Journal     Open Access   (Followers: 10)
European Journal of Emergency Medicine     Hybrid Journal   (Followers: 23)
Frontiers in Emergency Medicine     Open Access   (Followers: 8)
Global Journal of Transfusion Medicine     Open Access   (Followers: 1)
Hong Kong Journal of Emergency Medicine     Full-text available via subscription   (Followers: 5)
Indian Journal of Burns     Open Access   (Followers: 2)
Injury     Hybrid Journal   (Followers: 20)
Intensive Care Medicine     Hybrid Journal   (Followers: 82)
Intensive Care Medicine Experimental     Open Access   (Followers: 2)
Intensivmedizin up2date     Hybrid Journal   (Followers: 4)
International Journal of Critical Illness and Injury Science     Open Access   (Followers: 1)
International Journal of Emergency Medicine     Open Access   (Followers: 9)
International Journal of Emergency Mental Health and Human Resilience     Open Access   (Followers: 2)
International Paramedic Practice     Full-text available via subscription   (Followers: 14)
Iranian Journal of Emergency Medicine     Open Access  
Irish Journal of Paramedicine     Open Access   (Followers: 2)
Journal Européen des Urgences et de Réanimation     Hybrid Journal   (Followers: 1)
Journal of Acute Care Physical Therapy     Hybrid Journal   (Followers: 3)
Journal of Cardiac Critical Care TSS     Open Access   (Followers: 1)
Journal Of Cardiovascular Emergencies     Open Access  
Journal of Concussion     Open Access  
Journal of Critical Care     Hybrid Journal   (Followers: 48)
Journal of Critical Care Medicine     Open Access   (Followers: 18)
Journal of Education and Teaching in Emergency Medicine     Open Access   (Followers: 1)
Journal of Emergencies, Trauma and Shock     Open Access   (Followers: 13)
Journal of Emergency Medical Services     Full-text available via subscription   (Followers: 12)
Journal of Emergency Medicine     Hybrid Journal   (Followers: 53)
Journal of Emergency Medicine, Trauma and Acute Care     Open Access   (Followers: 25)
Journal of Emergency Practice and Trauma     Open Access   (Followers: 6)
Journal of Intensive Care     Open Access   (Followers: 9)
Journal of Intensive Care Medicine     Hybrid Journal   (Followers: 22)
Journal of Intensive Medicine     Open Access  
Journal of Neuroanaesthesiology and Critical Care     Open Access   (Followers: 3)
Journal of Stroke Medicine     Hybrid Journal  
Journal of the American College of Emergency Physicians Open     Open Access   (Followers: 1)
Journal of the Intensive Care Society     Hybrid Journal   (Followers: 4)
Journal of the Royal Army Medical Corps     Hybrid Journal   (Followers: 6)
Journal of Thrombosis and Haemostasis     Hybrid Journal   (Followers: 81)
Journal of Translational Critical Care Medicine     Open Access   (Followers: 5)
Journal of Trauma and Acute Care Surgery, The     Hybrid Journal   (Followers: 34)
La Presse Médicale Open     Open Access  
Médecine de Catastrophe - Urgences Collectives     Hybrid Journal  
Medicina Intensiva     Open Access   (Followers: 3)
Medicina Intensiva (English Edition)     Hybrid Journal   (Followers: 1)
Mediterranean Journal of Emergency Medicine & Acute Care : MedJEM     Open Access  
Notfall + Rettungsmedizin     Hybrid Journal   (Followers: 3)
OA Critical Care     Open Access   (Followers: 3)
OA Emergency Medicine     Open Access   (Followers: 2)
Open Access Emergency Medicine     Open Access   (Followers: 6)
Open Journal of Emergency Medicine     Open Access   (Followers: 2)
Palliative Care : Research and Treatment     Open Access   (Followers: 19)
Palliative Medicine     Hybrid Journal   (Followers: 54)
Prehospital Emergency Care     Hybrid Journal   (Followers: 19)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 41)
Research and Opinion in Anesthesia and Intensive Care     Open Access   (Followers: 3)
Resuscitation     Hybrid Journal   (Followers: 54)
Resuscitation Plus     Open Access   (Followers: 2)
Saudi Critical Care Journal     Open Access   (Followers: 2)
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine     Open Access   (Followers: 11)
Seminars in Thrombosis and Hemostasis     Hybrid Journal   (Followers: 46)
Shock : Injury, Inflammation, and Sepsis : Laboratory and Clinical Approaches     Hybrid Journal   (Followers: 10)
Sklifosovsky Journal Emergency Medical Care     Open Access  
The Journal of Trauma Injury Infection and Critical Care     Full-text available via subscription   (Followers: 24)
Therapeutics and Clinical Risk Management     Open Access   (Followers: 2)
Transplant Research and Risk Management     Open Access  
Trauma Case Reports     Open Access   (Followers: 1)
Trauma Monthly     Open Access   (Followers: 3)
Visual Journal of Emergency Medicine     Full-text available via subscription   (Followers: 1)
Western Journal of Emergency Medicine     Open Access   (Followers: 11)
 AEM Education and Training : A Global Journal of Emergency Care     Open Access   (Followers: 1)

           

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Journal Cover
Critical Care Research and Practice
Journal Prestige (SJR): 0.499
Citation Impact (citeScore): 1
Number of Followers: 13  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2090-1305 - ISSN (Online) 2090-1313
Published by Hindawi Homepage  [339 journals]
  • Noninvasive Mechanical Ventilation with Average Volume-Assured Pressure
           Support versus BiPAP S/T in De Novo Hypoxemic Respiratory Failure

    • Abstract: Background. Bilevel positive airway pressure in spontaneous/time and average volume-assured pressure support (BiPAP·S/T–AVAPS) could maintain an adequate tidal volume by reducing the patient’s inspiratory effort; however, this ventilatory strategy has not been compared with other ventilatory modes, especially the conventional BiPAP S/T mode, when noninvasive mechanical ventilation (NIMV) is used. The primary objective of this study was to determine the rate of success and failure of the use of BiPAP·S/T-AVAPS versus BiPAP·S/T alone in patients with mild-to-moderate “de novo” hypoxemic respiratory failure. Methods. This was a matched-cohort study. Subjects with mild-to-moderate de novo hypoxemic respiratory failure were divided into two groups according to the ventilatory strategy used. The subjects in the BiPAP·S/T group were paired with those in the BiPAP·S/T-AVAPS group. Results. A total of 58 subjects were studied. Twenty-nine subjects in the BiPAP·S/T group were paired with 29 subjects in the BiPAP·S/T-AVAPS group. Twenty patients (34.5%) presented with “failure of NIMV,” while 38 (65.5%) patients did not. In addition, 13 (22.4%) patients died, while 45 (77.6%) recovered. No differences were found in the percentage of intubation () and mortality ().Conclusion. The BiPAP S/T-AVAPS ventilator mode was not superior to the BiPAP·S/T mode. A high mortality rate was observed in patients with NIMV failure in both modes. This trial is registered with https://doi.org/10.1186/ISRCTN17904857.
      PubDate: Wed, 03 Aug 2022 11:20:00 +000
       
  • Is the Critical Care Resuscitation Unit Sustainable: A 5-Year Experience
           of a Beneficial and Novel Model

    • Abstract: Background. The 6-bed critical care resuscitation unit (CCRU) is a unique and specialized intensive care unit (ICU) that streamlines the interhospital transfer (IHT—transfer between different hospitals) process for a wide range of patients with critical illness or time-sensitive disease. Previous studies showed the unit successfully increased the number of ICU admissions while reducing the time of transfer in the first year of its establishment. However, its sustainability is unknown. Methods. This was a descriptive retrospective analysis of adult, non-trauma patients who were transferred to an 800-bed quaternary medical center. Patients transferred to our medical center between January 1, 2014 and December 31, 2018 were eligible. We used interrupted time series (ITS) and descriptive analyses to describe the trend and compare the transfer process between patients who were transferred to the CCRU versus those transferred to other adult inpatient units. Results. From 2014 to 2018, 50,599 patients were transferred to our medical center; 31,582 (62%) were non-trauma adults. Compared with the year prior to the opening of the CCRU, ITS showed a significant increase in IHT after the establishment of the CCRU. The CCRU received a total of 7,788 (25%) IHTs during this period or approximately 20% of total transfers per year. Most transfers (41%) occurred via ground. Median and interquartile range [IQR] of transfer times to other ICUs (156 [65–1027] minutes) were longer than the CCRU (46 [22–139] minutes, ). For the CCRU, the most common accepting services were cardiac surgery (16%), neurosurgery (11%), and emergency general surgery (10%). Conclusions. The CCRU increases the overall number of transfers to our institution, improves patient access to specialty care while decreasing transfer time, and continues to be a sustainable model over time. Additional research is needed to determine if transferring patients to the CCRU would continue to improve patients’ outcomes and hospital revenue.
      PubDate: Tue, 19 Jul 2022 14:05:01 +000
       
  • Patient Perception of Informed Consent and Its Associated Factors among
           Surgical Patients Attending Public Hospitals in Dessie City
           Administration, Northeast Ethiopia

    • Abstract: Background. Poor perception of informed consent compromises patients’ autonomy and self-determination; as a result, they feel powerless and unaccountable for their treatment. This study aimed to assess patients’ perception of informed consent and its associated factors among surgical patients attending public hospitals in Dessie City Administration, Northeast Ethiopia. Methods. Facility-based cross-sectional study was conducted on 422 surgical patients. A systematic sampling technique was used to select the study participants. Data were collected using a pretested structured interviewer-administered questionnaire. EpiData version 3.1 was used for data entry, and then data were exported to SPSS version 25 for analysis. Multivariable logistic regression analysis was done to identify factors associated with the outcome variable among the participants. Variables with value less than 0.05 were considered statistically significant factors. Results. The prevalence of poor perception of informed consent for surgical procedures was found to be 33.2% (95% CI: 28.8–37.8). In multivariable analysis, educational status with inability to read and write (AOR = 5.71; 95% CI: 2.76–11.80) and basic ability to read and write (AOR = 6.03; 95% CI: 2.57–14.16), rural residence (AOR = 3.71; 95% CI: 1.94–7.07), marital status being widowed and divorced (AOR = 3.85; 95% CI: 1.83–8.08), language of written informed consent different from mother tongue (AOR = 4.196; 95% CI: 1.12–15.78), poor patient-physician relationship (AOR = 2.35; 95% CI: 1.31–4.24), and poor knowledge of surgical informed consent (AOR = 3.05; 95% CI: 1.56–5.97) were significantly associated with poor perception of surgical informed consent. Conclusion. In this study, one-third of surgical patients appear to have poor perceptions of informed consent for surgical procedures. Educational status, being rural residents, being widowed/divorced, language of written informed consent, poor patient-physician relationship, and poor knowledge of surgical informed consent were variables that are independent predictors of poor perception of informed consent for surgical procedures. The ministry of health and healthcare providers should develop a plan to raise patients’ awareness about the informed consent process for surgical procedures.
      PubDate: Fri, 01 Jul 2022 05:20:01 +000
       
  • The Positive and Negative Effects of Calcium Supplementation on Mortality
           in Septic ICU Patients Depend on Disease Severity: A Retrospective Study
           from the MIMIC-III

    • Abstract: Background. Calcium administration in septic patients with hypocalcemia is a controversial issue. The present study preliminarily investigated the effects of calcium supplementation on the length of hospitalization and mortality in septic ICU patients with different severities of hypocalcemia and disease. Method. A total of 5761 eligible septic patients, including 2689 who received calcium supplementation and 3072 who did not receive calcium supplementation, were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The cofounding covariates between the calcium supplement and nonsupplement groups were balanced using the propensity score matching model. We compared the length of stay (LOS) in the ICU and hospital with 28-day and hospital mortality and stratified the analysis according to the sequential organ failure assessment (SOFA) score and ionized calcium (iCa) at the first ICU admission in the matched groups. Results. The results showed that iCa at the first ICU admission was associated with mortality in sepsis patients (HR: 0.421; 95% CI: 0.211∼0.837), but the lowest mortality rate was observed in patients with mild hypocalcemia. A total of 993 paired patients were included in the analysis after propensity score matching. Regardless of the SOFA score or presence of iCa, the LOS in the ICU was higher in the calcium supplement group than in the nonsupplement group. The survival analysis was stratified by the SOFA score and showed that calcium supplementation reduced mortality when the patient’s SOFA score was ≥8 (), and it worsened the outcome when the patient’s SOFA score was ≤4 (). It had no significant effect on patients with SOFA scores ranging from 5 to 7 ().Conclusion. Our results showed that mild hypocalcemia may be protective in septic patients, and calcium supplementation may have positive and negative effects on mortality depending on disease severity. The SOFA score may be a valuable clinical index for decisions regarding calcium administration.
      PubDate: Wed, 22 Jun 2022 09:35:00 +000
       
  • The Feasibility of Percutaneous Dilatational Tracheostomy in
           Immunosuppressed ICU Patients with or without Thrombocytopenia

    • Abstract: Background. Percutaneous dilatational tracheostomy (PDT) has become the preferred method in several intensive care units (ICUs), but data on PDT performed in immunosuppressed and thrombocytopenic patients are scarce. This study aimed to analyze the feasibility of PDT in immunosuppressed and thrombocytopenic patients compared to conventional open surgical tracheostomy (OST). Methods. We retrospectively analyzed the charts of patients who underwent PDT or OST between May 2017 and November 2020. Our outcomes were stoma site infections and bleeding complications. Results. 63 patients underwent PDT, and 21 patients underwent OST. Distribution of gender ratio, age, SAPS II, time of ventilation before tracheostomy, and preexisting hematooncological diseases was comparable between the two groups. After allogeneic stem cell transplantation (alloSCT), patients were more likely to undergo PDT than OST (). The PDT cohort suffered from mucositis more frequently (). There were no significant differences in leucocyte or platelet count on the tracheostomy day. Patients with coagulation disorders and patients under immunosuppression were distributed equally among both groups. Stoma site infection was documented in five cases in PDT and eight cases in the OST group. Moderate infections were remarkably increased in the OST group. Smears were positive in six cases in the PDT group; none of these patients had local infection signs. In the OST group, smears were positive in four cases; all had signs of a stroma site infection. Postprocedural bleedings occurred in eight cases (9.5%) and were observed significantly more often in the OST group (), leading to emergency surgery in one case of the OST group. Conclusion. PDT is a feasible and safe procedure in a predominantly immunosuppressed and thrombocytopenic patient cohort without an increased risk for stoma site infections or bleeding complications.
      PubDate: Thu, 26 May 2022 08:50:00 +000
       
  • The Validity of Quantifying Pulmonary Contusion Extent by Lung Ultrasound
           Score for Predicting ARDS in Blunt Thoracic Trauma

    • Abstract: Background. Thoracic trauma comprises 20–25% of all traumas worldwide and constitutes the third most common cause of death after abdominal injury and head trauma in polytrauma patients. Pulmonary contusion (PC) is a common injury seen after blunt trauma that is associated with significant morbidity and mortality. The aim of this prospective study was to determine the value of PC extent measurements using lung ultrasound in predicting high risk patients for ARDS development. Methods. In one year, 50 polytrauma patients with blunt chest trauma were admitted to the ICU at Damanhur Institute. Lung contusion extent was evaluated using a lung US score (LUS) and was compared to the CT contusion score. The ability of the LUS to predict ARDS was tested. The diagnostic accuracy of LUS was compared with chest radiography for lung contusion and pneumothorax with thoracic CT scan as a reference. Patients were restratified by LUS into two groups: severe and nonsevere contusion group. The two groups' data were compared with respect to difference in mortality and injury characteristics. Results. Lung contusion assessed by LUS score was well correlated to thoracic CT scan measurements (r = 0.78). A LUS of 4 was defined as a cut-off value for predicting ARDS development within 72 hours of trauma with sensitivity and specificity (91.67% and 84.21%), respectively. Patients with severe lung contusions had a lower hypoxic index on admission, more ventilator days, a higher risk of ARDS development, more fractured ribs; higher rate of hemothorax and a higher ISS score than patients with nonsevere lung contusions. Conclusion. LUS on admission can quantify lung contusion extent and the high risk of developing ARDS after blunt thoracic trauma.
      PubDate: Tue, 24 May 2022 08:35:01 +000
       
  • Ketamine Boluses Are Associated with a Reduction in Intracranial Pressure
           and an Increase in Cerebral Perfusion Pressure: A Retrospective
           Observational Study of Patients with Severe Traumatic Brain Injury

    • Abstract: Background. Increased intracranial pressure (ICP) and hypotension have long been shown to lead to worse outcomes in the severe traumatic brain injury (TBI) population. Adequate sedation is a fundamental principle in TBI care, and ketamine is an attractive option for sedation since it does not commonly cause systemic hypotension, whereas most other sedative medications do. We evaluated the effects of ketamine boluses on both ICP and cerebral perfusion pressure (CPP) in patients with severe TBI and refractory ICP. Methods. We conducted a retrospective review of all patients admitted to the neurointensive care unit at a single tertiary referral center who had a severe traumatic brain injury with indwelling intracranial pressure monitors. We identified those patients with refractory intracranial pressure who received boluses of ketamine. We defined refractory as any sustained ICP greater than 20 mmHg after the patient was adequately sedated, serum Na was at goal, and CO2 was maintained between 35 and 40 mmHg. The primary outcome was a reduction in ICP with a subsequent increase in CPP. Results. The patient cohort consisted of 44 patients with a median age of 30 years and a median presenting Glasgow Coma Scale (GCS) of 5. The median reduction in ICP after administration of a ketamine bolus was −3.5 mmHg (IQR −9 to +1), and the postketamine ICP was significantly different from baseline (). Ketamine boluses led to an increase in CPP by 2 mmHg (IQR −5 to +12), which was also significantly different from baseline ().Conclusion. In this single-institution study of patients with severe traumatic brain injury, ketamine boluses were associated with a reduction in ICP and an increase in CPP. This was a retrospective review of 43 patients and is therefore limited in nature, but further randomized controlled trials should be performed to confirm the findings.
      PubDate: Sat, 21 May 2022 07:35:00 +000
       
  • Statin Use and Mortality among Patients Hospitalized with Sepsis: A
           Retrospective Cohort Study within Southern California, 2008–2018

    • Abstract: Background. Despite early goal-directed therapy, sepsis mortality remains high. Statins exhibit pleiotropic effects. Objective. We sought to compare mortality outcomes among statin users versus nonusers who were hospitalized with sepsis. Methods. Retrospective cohort study of patients (age ≥18 years) during 1/1/2008–9/30/2018. Mortality was compared between statin users and nonusers and within statin users (hydrophilic versus lipophilic, fungal versus synthetic derivation, and individual statins head-to-head). Multivariable Cox regression models were used to estimate hazard ratios (HR) for 30-day and 90-day mortality. Inverse probability treatment weighting (IPTW) analysis was performed to account for indication bias. Results. Among 128,161 sepsis patients, 34,088 (26.6%) were prescribed statin drugs prior to admission. Statin users compared to nonusers had a 30-day and 90-day mortality HR (95% CI) of 0.80 (0.77–0.83) and 0.79 (0.77–0.81), respectively. Synthetic derived statin users compared to fungal derived users had a 30- and 90-day mortality HR (95% CI) of 0.86 (0.81–0.91) and 0.85 (0.81–0.89), respectively. Hydrophilic statin users compared to lipophilic users had a 30-day and 90-day mortality HR (95% CI) of 0.90 (0.81–1.01) and 0.86 (0.78–0.94), respectively. Compared to simvastatin, 30-day mortality HRs (95% CI) were 0.85 (0.66–1.10), 0.87 (0.82–0.92), 0.87 (0.76–0.98), and 1.22 (1.10–1.36) for rosuvastatin, atorvastatin, pravastatin, and lovastatin, respectively. Conclusion. Statin use was associated with lower mortality in patients hospitalized with sepsis. Hydrophilic and synthetic statins were associated with better outcomes than lipophilic and fungal-based preparations.
      PubDate: Fri, 06 May 2022 08:50:00 +000
       
  • Assessment of Occupational Burnout among Intensive Care Unit Staff in
           Jazan, Saudi Arabia, Using the Maslach Burnout Inventory

    • Abstract: Objective. ICU workers are among the healthcare staff exposed to high occupational burnout in their daily interactions with patients, especially during the COVID-19 pandemic. This study aimed to investigate the prevalence and risk factors of burnout among ICU staff in the Jazan region of Saudi Arabia. Methods. A cross-sectional study was conducted using the Maslach Burnout Inventory (MBI), which was distributed to ICU staff between August 1 and November 30, 2021. A total of 150 ICU workers were invited to participate in the study. Results. A total of 104 ICU staff responded to the survey (69% response rate), including 62 nurses, 30 physicians, and 12 respiratory therapists. Among the respondents, 63 (61%) were female and 41 (39%) were male. The mean scores for emotional exhaustion, depersonalization, and personal accomplishment were 22.44 ± 14.92, 9.18 ± 7.44, and 29.58 ± 12.53, respectively. The ICU staff at high risk of emotional exhaustion, depersonalization, and personal accomplishment were 36%, 28%, and 47%, respectively. The leading cause of burnout among ICU staff in the study was workload, and taking a vacation was the most cited coping mechanism for occupational burnout. Conclusion. ICU staff are at high risk of emotional exhaustion, depersonalization, and lack of personal accomplishment. Policymakers should implement regulations that ensure hospitals have adequate employees to reduce the workload that leads to occupational burnout.
      PubDate: Sat, 16 Apr 2022 09:20:00 +000
       
  • Predicting Outcomes for Interhospital Transferred Patients of Emergency
           General Surgery

    • Abstract: Background. Interhospital transferred (IHT) emergency general surgery (EGS) patients are associated with high care intensity and mortality. However, prior studies do not focus on patient-level data. Our study, using each IHT patient’s data, aimed to understand the underlying cause for IHT EGS patients’ outcomes. We hypothesized that transfer origin of EGS patients impacts outcomes due to critical illness as indicated by higher Sequential Organ Failure Assessment (SOFA) score and disease severity. Materials and Methods. We conducted a retrospective analysis of all adult patients transferred to our quaternary academic center’s EGS service from 01/2014 to 12/2016. Only patients transferred to our hospital with EGS service as the primary service were eligible. We used multivariable logistic regression and probit analysis to measure the association of patients’ clinical factors and their outcomes (mortality and survivors’ hospital length of stay [HLOS]). Results. We analyzed 708 patients, 280 (39%) from an ICU, 175 (25%) from an ED, and 253 (36%) from a surgical ward. Compared to ED patients, patients transferred from the ICU had higher mean (SD) SOFA score (5.7 (4.5) vs. 2.39 (2), ), longer HLOS, and higher mortality. Transferring from ICU (OR 2.95, 95% CI 1.36–6.41, ), requiring laparotomy (OR 1.96, 95% CI 1.04–3.70, ), and SOFA score (OR 1.22, 95% CI 1.13–1.32, ) were associated with higher mortality. Conclusions. At our academic center, patients transferred from an ICU were more critically ill and had longer HLOS and higher mortality. We identified SOFA score and a few conditions and diagnoses as associated with patients’ outcomes. Further studies are needed to confirm our observation.
      PubDate: Fri, 15 Apr 2022 14:20:00 +000
       
  • Evaluation of Minnesota Score in the Allocation of Venovenous
           Extracorporeal Membrane Oxygenation During Resource Scarcity

    • Abstract: Background. In this study, we evaluate the previously reported novel Minnesota Score for association with in-hospital mortality and allocation of venovenous extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome with or without SARS-CoV-2 pneumonia. Methods. This was a retrospective cohort study across four extracorporeal membrane oxygenation centers in Minnesota. Logistic regression was used to assess the relationship between the scores and in-hospital mortality, duration of ECMO cannulation, and discharge disposition. Priority groups were established statistically by maximizing the sum of sensitivity and specificity and compared to the previous qualitatively established priority groups. Results. Of 124 patients included in the study, 38% were treated for COVID-19 acute respiratory distress syndrome. The median age was 48 years, and 73% were male. The in-hospital mortality rate was 38%. The Minnesota Score was significantly associated with in-hospital mortality only (OR 1.13, ). Statistically determined cut points were similar to qualitative cut points. SARS-CoV-2 status did not change the findings. Conclusions. In our patient cohort, the Minnesota Score is associated with increased mortality. With further validation, proposed priority groups could be utilized for allocation of ECMO in times of increasing scarcity.
      PubDate: Wed, 06 Apr 2022 10:05:00 +000
       
  • Safety of Vasopressor Medications through Peripheral Line in Pediatric
           Patients in PICU in a Resource-Limited Setting

    • Abstract: Objective. Central venous catheter (CVC) placement in children in resource-limited settings (RLSs) can be a difficult task. Timely administration of vasopressor medications (VMs) through peripheral intravenous line (PIV) can help overcome this limitation. We aim to determine the safety of administration of vasopressor medications through PIVs in children admitted to pediatric intensive care unit (PICU) in a RLS. Design. Prospective observational study. Setting. An eight-bedded PICU of a tertiary care hospital. Patients. Children aged 1 month to 18 years admitted to the PICU. Intervention. None. Measurements and Main Results. All children (aged 1 month–18 years) who received VMs through PIV line from January 2019 to December 2019 were prospectively followed for the development of extravasation, conversion to CVC, duration of infusion, maximum dose of VMs used, maximum vasopressor inotropic score (VIS), and coadministration of vasopressor medication through PIV line. Results are presented as means with standard deviation and frequency with percentages. A total of 369 patients were included in the study, 221 (59.9%) were males, and the median age of the study population was 24 months (IQR; 6–96). Epinephrine was the most frequently used vasopressor medication (n = 279, 75.6%), followed by milrinone (n = 93, 25.2%), norepinephrine (n = 42, 11.4%), and dopamine (n = 32, 8.7%). The maximum dose of vasopressor medication was 0.25 µg/kg/min (epinephrine), 0.2 µg/kg/min (norepinephrine), 15 µg/kg/min (dopamine), and 0.8 µg/kg/min (milrinone). Extravasation was observed in 8 (2.2%) patients, while PIV line was converted to CVC in 127 (34.4%) children. Maximum dose of epinephrine, norepinephrine, VIS score, and PRISM Score was associated with conversion to CVC (p 
      PubDate: Thu, 31 Mar 2022 09:20:00 +000
       
  • Naloxegol to Prevent Constipation in ICU Adults Receiving Opioids: A
           Randomized Double-Blind Placebo-Controlled Pilot Trial

    • Abstract: Background. Constipation is frequent in critically ill adults receiving opioids. Naloxegol (N), a peripherally acting mu-receptor antagonist (PAMORA), may reduce constipation. The objective of this trial was to evaluate the efficacy and safety of N to prevent constipation in ICU adults receiving opioids. Methods and Patients. In this single-center, double-blind, randomized trial, adults admitted to a medical ICU receiving IV opioids (≥100 mcg fentanyl/day), and not having any of 17 exclusion criteria, were randomized to N (25 mg) or placebo (P) daily randomized to receive N (25mg) or placebo (P) and docusate 100 mg twice daily until ICU discharge, 10 days, or diarrhea (≥3 spontaneous bowel movement (SBM)/24 hours) or a serious adverse event related to study medication. A 4-step laxative protocol was initiated when there was no SBM ≥3 days. Results. Only 318 (20.6%) of the 1542 screened adults during the 1/17–10/19 enrolment period met all inclusion criteria. Of these, only 19/381 (4.9%) met all eligibility criteria. After 7 consent refusals, 12 patients were randomized. The study was stopped early due to enrolment futility. The N (n = 6) and (n = 6) groups were similar. The time to first SBM (N 41.4 ± 31.7 vs. P 32.5 ± 25.4 hours,  = 0.56) was similar. The maximal daily abdominal pressure was significantly lower in the N group (N 10 ± 4 vs. P 13 ± 5,  = 0.002). The median (IQR) daily SOFA scores were higher in N (N 7 (4, 8) vs. P 4 (3, 5),  
      PubDate: Sun, 20 Mar 2022 10:35:00 +000
       
  • Nurses’ Knowledge, Perceived Practice, and their Associated Factors
           regarding Deep Venous Thrombosis (DVT) Prevention in Amhara Region
           Comprehensive Specialized Hospitals, Northwest Ethiopia, 2021: A
           Cross-Sectional Study

    • Abstract: Introduction. Deep venous thrombosis is a preventable and treatable cause of death among hospitalized patients. Nurses’ knowledge and proper assessment can play a major role in improving deep venous thrombosis prevention care. Objective. To assess the knowledge, practice, and associated factors towards deep venous thrombosis prevention among nurses working at Amhara region hospitals. Methods. Institutional-based cross-sectional study was conducted among nurses working at Amhara region comprehensive specialized hospitals, Northwest, Ethiopia, from April 1 to 30, 2021. A simple random sampling technique was used to select 423 samples. A structured pretested self-administered questionnaire was used to collect data. Data were entered in epi-info version 7, analyzed using SPSS version 25, and presented by frequencies, percentages, and tables. Bivariable and multivariable logistic regression was computed, and P value < 0.05 was considered to identify statistically significant factors. Result. Good knowledge and practice of nurses towards DVT prevention were 55.6% and 48.8%, respectively. Working at the medical ward [AOR 3.175, 95% CI (1.42, 7.11)], having a BSc degree [AOR = 3.248(1.245, 8.469)], Master’s degree [AOR = 3.48, 95% CI (1.22, 9.89)], obtaining a formal training about deep venous thrombosis [AOR = 1.59; 95% CI (1.03, 2.47)], and working experience of ≥11 years [AOR = 2.11; 95% CI (1.07, 4.16)] were associated with good knowledge of nurses on the prevention of deep venous thrombosis. While having good knowledge about deep venous prevention AOR = 1.75; 95% CI (1.15, 2.65)] and working experience ≥11 years [AOR = 3.44; 95% CI (1.45, 8.13)] were significantly associated with nurses’ practice about deep venous thrombosis prevention. Conclusion. Knowledge and practice of the nurses regarding the prevention of deep venous thrombosis were found to be inadequate. Therefore, providing training, creating a conducive environment for sharing of experience, and upgrading the academic status of nurses are measures to scale up the knowledge and practice of nurses regarding deep venous thrombosis prevention.
      PubDate: Wed, 16 Mar 2022 06:35:00 +000
       
  • ICU Length of Stay and Factors Associated with Longer Stay of Major Trauma
           

    • Abstract: Background. Chest injury with multiple rib fractures is the most common injury among major trauma patients in New South Wales (23%) and is associated with a high rate of mortality and morbidity. The aim of this study was to determine the intensive care unit (ICU) length of stay (LOS) among major trauma patients with multiple rib fractures and to identify factors associated with a prolonged ICU LOS. Materials and Methods. Single-centre, retrospective observational cohort study of adult patients with 3 or more traumatic rib fractures, who were admitted to ICU between June 2014 and June 2019. A comparison was made between patients who stayed in ICU for less than 7 days and those that stay for 7 or more days. Results. Among 215 patients who were enrolled, 150 (69.7%) were male, the median Injury Severity Score (ISS) was 24 (interquartile range (IQR): 17–32). The median ICU LOS was 4 (IQR: 2–7) days and the average ICU LOS was 6.5 (SD 8.5; 95% CI 5.3–7.6) days. The median number of rib fractures was 6 (IQR: 5–9) and 76 (35.3%) patients had a flail chest. Patients who stayed longer than 7 days in ICU had higher ISS, higher APACHE-II score, greater number of rib fractures, higher rate of lung contusions, and required more respiratory support of any type. Conclusions. ISS, number of rib fractures, lung contusion, and flail chest were associated with prolonged ICU LOS in patients with traumatic multiple rib fractures.
      PubDate: Tue, 01 Mar 2022 10:20:01 +000
       
  • Effect of Oral Vasopressors Used for Liberation from Intravenous
           Vasopressors in Intensive Care Unit Patients Recovering from Spinal Shock:
           A Randomized Controlled Trial

    • Abstract: Background. Early vasopressor utilization has been associated with improved outcomes of patients with spinal shock; however, there are difficulties in weaning off vasopressors, in which patients after recovery from spinal shock develop a state of persistent vasodilation, which may take a few days to resolve and delays the discharge in the intensive care unit (ICU). Therefore, we tested the hypothesis using two oral vasopressors (midodrine and minirin) to facilitate weaning off intravenous vasopressors, reducing the ICU length of stay, and compare them for more efficacy. Methods. A randomized controlled trial was conducted in the trauma ICU at the Assiut University Hospital in Egypt in patients with spinal shock who required intravenous vasopressor for ≥24 h. A convenience sample was classified into three groups, in which 30 patients were included for each group. The midodrine group received midodrine 10 mg per oral every 8 h with gradual weaning off intravenous (IV) vasopressor (noradrenaline) after receiving 4 doses, the minirin group received minirin 60 μg per oral every 8 h with gradual weaning off IV vasopressor after receiving 4 doses, whereas the control group received IV vasopressor (noradrenaline) with gradual weaning according to the routine hospital care without adding oral vasopressors. The primary outcome was shortening the duration of IV vasopressor requirements. The secondary outcome was reducing the ICU length of stay. Results. Our results showed that the duration of IV vasopressor requirements in the midodrine (3.3 ± 1.32) and minirin groups (4.8 ± 1.83) was significantly lower than in the control group (6.93 ± 2.32). Additionally, the ICU length of stay (days) in the midodrine (5.13 ± 1.83) and minirin groups (5.5 ± 1.91) was significantly lower than in the control group (9.03 ± 3.74). Conclusion. Midodrine and minirin accelerated liberation from intravenous noradrenaline and effective in reducing the ICU length of stay in patients with spinal shock.
      PubDate: Tue, 18 Jan 2022 11:05:01 +000
       
  • Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane
           Oxygenation (ECMO): Prognosis and Predictors

    • Abstract: Background. Major bleeding has been a common and serious complication with poor outcomes in ECMO patients. With a novel, less-invasive cannulation approach and closer coagulation monitoring regime, the incidence of major bleeding is currently not determined yet. Our study aims to examine the incidence of major bleeding, its determinants, and association with mortality in peripheral-ECMO patients. Method. We conducted a single-center retrospective study on adult patients undergoing peripheral-ECMO between January 2019 and January 2020 at a tertiary referral hospital. Determinants of major bleeding were defined by logistic regression analysis. Risk factors of in-hospital mortality were determined by Cox proportional hazard regression analysis. Results. Major bleeding was reported in 33/105 patients (31.4%) and was associated with higher in-hospital mortality [adjusted hazard ratio (aHR) 3.56, 95% confidence interval (CI) 1.63–7.80, ). There were no significant difference in age, sex, ECMO indications, ECMO modality, pre-ECMO APACHE-II and SOFA scores between two groups with and without major bleeding. Only APTT>72 seconds [adjusted odds ratio (aOR) 7.10, 95% CI 2.60–19.50, ], fibrinogen 220 seconds [aOR = 3.9, 95% CI 1.20–11.80, ] on days with major bleeding were independent predictors. Conclusions. In summary, major bleeding still had a fairly high incidence and poor outcome in peripheral-ECMO patients. APTT > 72 seconds, fibrinogen 
      PubDate: Sat, 15 Jan 2022 09:50:01 +000
       
  • Incidence and Risk Factors of Ventilator-Associated Pneumonia among
           Patients with Delirium in the Intensive Care Unit: A Prospective
           Observational Study

    • Abstract: Introduction. The incidence and risk factors for ventilator-related pneumonia (VAP) in patients with delirium are deficient, and there is a lack of in-depth knowledge of the impact of VAP on outcomes in this population. We investigated the incidence, risk factors, and outcomes of VAP in patients with delirium. Materials and Methods. This prospective observational study was performed in a surgical ICU at Be’sat Hospital in Hamadan, Iran, between 2018 and 2019. A total of 108 patients with delirium were identified using the Confusion Assessment Method (CAM) for the ICU and Intensive Care Delirium Screening Checklist (ICDSC) and enrolled in this study. The association between VAP and delirium, risk factors, and outcomes (ICU length of stay and ICU mortality) for VAP were investigated using the Cox proportional hazards model and logistic and simple linear regression analyses with a 95% confidence interval. Results. Of 108 delirium patients, 86 patients (79.6%) underwent mechanical ventilation (MV) and 16 patients (18.6%) experienced VAP during ICU stay. The median onset of VAP was 6.5 (IQR 4.2–7.7) days after intubation. Delirium patients with VAP stayed longer in the ICU (21.68 ± 4.26 vs.12.93 ± 1.71, ) and also had higher ICU mortality (31.25% vs. 0%, ) than subjects without VAP. According to multivariate cox regression, the expected HR for VAP was 53.5% lower for patients with early-onset delirium than in patients with late-onset delirium (HR: 0.465, 95% CI: 0.241–0.894, ). However, the expected hazard for VAP was 1.854 times and 4.604 times higher in patients with longer ICU stay (HR: 1.854, 95% CI: 1.689–3.059, ) and in patients with a prolonged MV duration (HR: 4.604, 95%CI: 1.567–6.708, ).Conclusion. According to the results, there seems to be an inverse relationship between early onset of delirium and VAP. This finding cannot be conclusively cited, and more studies in this filed should be conducted with a larger sample size. Furthermore, VAP in delirium patients is associated with increases in poor outcomes (higher ICU mortality) and the use of medical resources (longer stay in the ICU and MV duration).
      PubDate: Thu, 13 Jan 2022 15:20:00 +000
       
 
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