The "fever workup" and respiratory culture practice in critically ill trauma patients.

Purpose: Fever and leukocytosis (FAL) in critically ill patients often triggers a "workup" that includes a respiratory secretion culture (RCx). We evaluated our respiratory culture practice associated with FAL. We hypothesized that FAL would be associated with a RCx, but would not be associated with a positive culture or treating a respiratory infection in critically injured patients during their first 14 intensive care unit (ICU) days.

Who is monitoring your infections: shouldn't you be?

Background: In the era of pay for performance and outcome comparisons among institutions, it is imperative to have reliable and accurate surveillance methodology for monitoring infectious complications. The current monitoring standard often involves a combination of prospective and retrospective analysis by trained infection control (IC) teams. We have developed a medical informatics application, the Surgical Intensive Care-Infection Registry (SIC-IR), to assist with infection surveillance.

Isolated cervical spine fractures in the elderly: a deadly injury.

Background: Traumatic injury in the elderly is an increasing problem and studies have shown that elderly patients (>/=65 years old) with cervical spine fractures and spinal cord injury (SCI) carry a mortality rate of 21% to 30%. However, little has been described with regard to outcomes for elderly patients with isolated cervical spine fractures (ICSF).

Hypothesis: Outcomes for elderly patients with ICSF will be similar to elderly patients with cervical fractures and associated traumatic injuries (ATI) or SCI.

Weaning readiness and fluid balance in older critically ill surgical patients.

Background: Few studies address predictors for successful weaning of older adults from mechanical ventilation.

Objective: To develop a clinical profile of older patients who are successfully weaned from long-term mechanical ventilation.

Methods: Forty patients in the trauma and surgical intensive care unit who were at least 60 years old were enrolled in the study after 3 days of active weaning and were monitored daily until successfully weaned or until the end of the 14-day study.

Energy expenditure assessment and validation after acute spinal cord injury.

Background: This study was designed to determine the applicability of the Harris Benedict (HB) equation in predicting energy requirements after acute spinal cord injury (SCI) and to evaluate the accuracy of a 30-minute energy expenditure measurement to determine 24-hour requirements. Prealbumin (PAB) was monitored weekly to assess the patient's response to the nutrition support regimen.

Methods: Patients with acute isolated SCI requiring mechanical ventilation were studied for 4 weeks postinjury.

Weaning older patients from long-term mechanical ventilation: a pilot study.

Background: As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation.

Objective: To describe temporal changes in pulmonary and systemic variables in older adults receiving long-term mechanical ventilation.

Methods: After 3 days of unsuccessful attempts at weaning from ventilatory support, 10 trauma and surgical patients more than 60 years old were monitored daily.

Early and late outcome of bedside percutaneous tracheostomy in the intensive care unit.

To simplify long-term airway management in critically ill patients the feasibility of performing percutaneous tracheostomy (PT) in the intensive care unit (ICU) was investigated from August of 1997 to March of 2000. Bedside PT was considered for patients with positive end-expiratory pressure <10 cm H20, no previous tracheostomy, no anatomic distortion of the tracheal region, and no other indication to go to the operating room. Indication for tracheostomy, duration of endotracheal intubation, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, morbidity, and mortality were determined.