A novel method of optimizing patient- and family-centered care in the ICU.

Background: Patient- and family-centered care permeates critical care where there are often multiple teams involved in management. A method of facilitating information sharing to support shared decision making is essential in appropriately rendering care.This study sought to determine whether incorporating family members on rounds in the intensive care unit (ICU) improves patient and family knowledge and whether doing so improves team time management and satisfaction with the process.

Understanding percutaneous and subcutaneous central venous access devices.

Central venous access devices (CVADs) are commonly used in the inpatient and outpatient settings. Physician assistants must understand CVADs' indications, intended uses, functional lifespans, complications, and indications for removal. This article describes common CVADs used for administering medications, nutrition, and chemotherapy, and for hemodialysis and venous access for laboratory sampling.

Bridging the gap between training and advanced practice provider critical care competency.

Given the meteoric rise in physician assistants and nurse practitioners in critical care units across the United States, identifying successful paradigms with which to train these clinicians is critical to help meet current and future demands. We describe an apprenticeship model of training that is deployable in any ICU including curriculum, didactic and procedural training, as well as 3- and 6-month benchmarks that embraces dedicated intensivist mentorship.

Ventilator gas delivery wave form substantially impacts plateau pressure and peak-to-plateau pressure gradient determination.

Background: To determine whether plateau pressure (Pplat) measurement is lowered and peak airway pressure (Pawpeak)-to-Plat gradient is increased by measurement on a decelerating compared with square gas delivery wave form.

Methods: Prospective before and after study of mechanically ventilated injured and critically ill patients in an adult surgical intensive care unit. Pplat, Pawpeak, and Pawpeak-to-Pplat gradient were measured on decelerating and square gas delivery wave forms.

When the ICU is the operating room.

Background: The surgical intensive care unit (SICU) is increasingly used as a surrogate operating room (OR). This study seeks to characterize a Level I trauma center's operative undertakings in the SICU versus OR for trauma and emergency general surgery patients.

Methods: Operative and ICU databases were queried for all operative procedures as a function of procedure type (CPT code) and location (OR, ICU) from August 2002 through June 2009.

Abdominal compartment syndrome: risk factors, diagnosis, and current therapy.

Abdominal compartment syndrome's manifestations are difficult to definitively detect on physical examination alone. Therefore, objective criteria have been articulated that aid the bedside clinician in detecting intra-abdominal hypertension as well as the abdominal compartment syndrome to initiate prompt and potentially life-saving intervention. At-risk patient populations should be routinely monitored and tiered interventions should be undertaken as a team approach to management.

Lessons learned from airway pressure release ventilation.

Background: The aim of this article is to review a single institution's experience with airway pressure release ventilation (APRV) with respect to safety, complications, and efficacy at correcting hypercarbia and hypoxemia.

Methods: Patients transitioned from either volume- or pressure-targeted ventilation to APRV in a university hospital surgical intensive care unit were retrospectively reviewed. Patients whose ventilator strategy started with APRV were excluded.

Uncovering system errors using a rapid response team: cross-coverage caught in the crossfire.

Background: Because of the 80-hour work week, extensive service cross-coverage creates great potential for patient care errors. These patient care emergencies are increasingly managed using a rapid response team (RRT) to reduce patient morbidity. We examine the proximate causes of a surgical RRT activation.

A physicochemical approach to acid-base balance in critically ill trauma patients minimizes errors and reduces inappropriate plasma volume expansion.

Background: This study assesses if a physicochemical (PC) approach to acid-base balance improves the accuracy of acid-base diagnosis, and reduces inappropriate fluid loading.

Methods: Hundred consecutive patients with trauma admitted to a surgical intensive care unit at a level I trauma center were prospectively analyzed. Demographics, acid-base data and diagnoses, and interventions were collected.

Endotracheal intubation: the role of sterility.

Background: There is a paucity of data regarding whether sterile handling of endotracheal tubes (ETTs) impacts the incidence and prevalence of pneumonia in the emergency, urgent, or elective clinical scenarios. Intensive care units employ infection control and reduction schemes to reduce pneumonia rates.

Methods: A MEDLINE search of the English-language literature for the last 30 years was performed using the keywords "endotracheal intubation," "intubation," "pneumonia," "sinusitis," "tracheobronchitis," "nosocomial infection," and "infection.