Exploration of a Multi-Parameter Technology for Pain Assessment in Postoperative Patients After Cardiac Surgery in the Intensive Care Unit: The Nociception Level Index (NOL).

Introduction: The aim of this study was to explore the use of a multi-parameter technology, the Nociception Level (NOL) index (Medasense Biometrics Ltd, Ramat Gan, Israel), for pain assessment in postoperative awake patients after cardiac surgery during non-nociceptive and nociceptive procedures in the intensive care unit (ICU).

Materials And Methods: A prospective cohort repeated-measures design was used. Patients were included if they were in the ICU after undergoing cardiac surgery and if they could self-report their pain.

Determinants of pain assessment documentation in intensive care units.

Purpose: The underassessment of pain is a major barrier to effective pain management, and the lack of pain assessment documentation has been associated with negative patient outcomes. This study aimed to 1) describe the contextual factors related to pain assessment and management in five Québec intensive care units (ICUs); 2) describe their pain assessment documentation practices; and 3) identify sociodemographic and clinical determinants related to pain assessment documentation.

Methods: A descriptive-correlational retrospective design was used.

Corrigendum to "A Case of Severe Acute Kidney Injury Exacerbated by Canagliflozin in a Patient with Type 2 Diabetes".

[This corrects the article DOI: 10.1155/2019/8639629.].

Outcomes and clinical practice in patients with COVID-19 admitted to the intensive care unit in Montréal, Canada: a descriptive analysis.

Background: The coronavirus disease 2019 (COVID-19) pandemic is responsible for millions of infections worldwide, and a substantial number of these patients will be admitted to the intensive care unit (ICU). Our objective was to describe the characteristics, outcomes and management of critically ill patients with COVID-19 pneumonia at a single designated pandemic centre in Montréal, Canada.

Methods: A descriptive analysis was performed on consecutive critically ill patients with COVID-19 pneumonia admitted to the ICU at the Jewish General Hospital, a designated pandemic centre in Montréal, between Mar.

Smartphone technology for fostering goal-directed ambulation and object use in people with moderate Alzheimer's disease.

This study was aimed at assessing a smartphone-based intervention to help 11 individuals with moderate Alzheimer's disease and ambulation problems to manage goal-directed, walker-assisted ambulation and object use (i.e., to reach specific destinations and put away objects at those destinations independently).

A Case of Severe Acute Kidney Injury Exacerbated by Canagliflozin in a Patient with Type 2 Diabetes.

Background: Sodium glucose cotransport (SGLT)-2 inhibitors are the newest class of antihyperglycemic agents used as second- or third-line treatment in the management of type 2 diabetes. Although the use of SGLT-2 inhibitors has not been shown to cause nephrotoxicity, there have been case reports of SGLT-2 inhibitor use being associated with acute kidney injury.

Case Presentation: A 72-year-old woman with a history of type 2 diabetes and no known chronic renal insufficiency presented to the emergency room with a 3-day history of nausea, vomiting, and increased somnolence.

Smartphone-Based Interventions to Foster Simple Activity and Personal Satisfaction in People With Advanced Alzheimer's Disease.

Objectives: This study assessed a smartphone-based program to promote practical and mildly demanding arm responses and personal satisfaction and increase physical exertion (heart rates) in people with advanced Alzheimer's disease.

Methods: The program relied on a Samsung Galaxy A3 smartphone with Android 6.0 operating system.

Technology-Based Behavioral Interventions for Daily Activities and Supported Ambulation in People With Alzheimer's Disease.

Objectives: These 2 studies evaluated technology-based behavioral interventions for promoting daily activities and supported ambulation in people with mild-to-moderate and moderate-to-severe Alzheimer's disease, respectively.

Methods: Study 1 included 8 participants who were taught to start and carry out daily activities on their own using a tablet or smartphone device, which provided activity reminders, step instructions, and praise. Study 2 included 9 participants who were taught to engage in brief periods of ambulation using a walker combined with a tilt microswitch and a notebook computer, which monitored step responses and provided stimulation and prompts.

Patient and Organizational Factors Associated With Delays in Antimicrobial Therapy for Septic Shock.

Objectives: To identify clinical and organizational factors associated with delays in antimicrobial therapy for septic shock.

Design: In a retrospective cohort of critically ill patients with septic shock.

Setting: Twenty-four ICUs.

People with multiple disabilities learn to engage in occupation and work activities with the support of technology-aided programs.

These two studies were aimed at assessing technology-aided programs to help persons with multiple disabilities engage in basic occupation or work activities. Specifically, Study I focused on teaching two participants (an adolescent and an adult) with low vision or total blindness, severe/profound intellectual disabilities, and minimal object interaction to engage in constructive object-manipulation responses. The technology monitored their responses and followed them with brief stimulation periods automatically.

The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated.

Background: Ventilator-associated conditions (VACs) and infection-related ventilator-associated complications (iVACs) are the Centers for Disease Control and Prevention's new surveillance paradigms for patients who are mechanically ventilated. Little is known regarding the clinical impact and preventability of VACs and iVACs and their relationship to ventilator-associated pneumonia (VAP). We evaluated these using data from a large, multicenter, quality-improvement initiative.

Trends, risk factors and mortality among women with venous thromboembolism during labour and delivery: a population-based study of 8 million births.

Objective: Venous thromboembolism (VTE) is amongst the main causes of maternal death in the developed world. The objective of this study is to elucidate risk factors of VTE and specifically, predictors of fatal thromboembolic disease during the delivery.

Study Design: We conducted a population-based cohort study on 8 million birth records using the Healthcare Cost and Utilisation Project-Nationwide Inpatient Sample from 1999 to 2008 to estimate the incidence and case fatality of VTE's during labour admission.

A computer-aided telephone system to enable five persons with Alzheimer's disease to make phone calls independently.

This study extended the assessment of a computer-aided telephone system to enable five patients with a diagnosis of Alzheimer's disease to make phone calls independently. The patients were divided into two groups and exposed to intervention according to a non-concurrent multiple baseline design across groups. All patients started with baseline in which the technology was not available, and continued with intervention in which the technology was used.

Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis.

Background And Purpose: Aspiration of secretions containing bacterial pathogens into the lower respiratory tract is the main cause of ventilator-associated pneumonia. Endotracheal tubes with subglottic secretion drainage can potentially reduce this and, therefore, the incidence of ventilator-associated pneumonia. New evidence on subglottic secretion drainage as a preventive measure for ventilator-associated pneumonia has been recently published and to consider the evidence in totality, we conducted an updated systematic review and meta-analysis.

Evidence of viremia in 2 cases of severe pandemic influenza A H1N1/09.

The recent pandemic of the 2009 pandemic influenza A (H1N1) infrequently caused severe disease. We describe 2 cases of 2009 H1N1 influenza with rapid progression resulting in respiratory failure and need for prolonged intensive care support. Real-time polymerase chain reaction amplification for influenza A (using a Centers for Disease Control and Prevention protocol) and the 2009 H1N1 influenza (using an in-house protocol) was performed on serial respiratory and serum specimens from both patients collected over 3 weeks.

Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: a propensity-matched analysis.

Background: Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broadening coverage when resistant pathogens are a concern.

Clinical relevance of ventilation during cardiopulmonary bypass in the prevention of postoperative lung dysfunction.

The current clinical study is the continuity of previous experimental findings in which ventilation during cardiopulmonary bypass (CPB) prevented reperfusion injury of the pulmonary arterial tree as demonstrated by preservation of vasorelaxation to acetylcholine (ACh) in swine. The aim of this prospective randomized study is to determine: 1) if ventilation during CPB prevents the selective endothelium-mediated lung dysfunction in humans and, 2) the clinical relevance of ventilation during CPB. Forty patients scheduled for primary coronary artery bypass grafting (CABG) were randomized into two groups: Group 1: Usual care (defined as no ventilation during CPB) and Group 2: CPB with low tidal volume ventilation (3 ml.

Bench-to-bedside review: dealing with increased intensive care unit staff turnover: a leadership challenge.

Critical care leaders frequently must face challenging situations requiring specific leadership and management skills for which they are, not uncommonly, poorly prepared. Such a fictitious scenario was discussed at a Canadian interdisciplinary critical care leadership meeting, whereby increasing intensive care unit (ICU) staff turnover had led to problems with staff recruitment. Participants discussed and proposed solutions to the scenario in a structured format.

A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients.

Background: Some observational studies suggest that the use of pulmonary-artery catheters to guide therapy is associated with increased mortality.

Methods: We performed a randomized trial comparing goal-directed therapy guided by a pulmonary-artery catheter with standard care without the use of a pulmonary-artery catheter. The subjects were high-risk patients 60 years of age or older, with American Society of Anesthesiologists (ASA) class III or IV risk, who were scheduled for urgent or elective major surgery, followed by a stay in an intensive care unit.

Prevention of venous thromboembolism in critically ill surgery patients: a cross-sectional study.

Background: The risk for venous thromboembolism (VTE) and the risk for bleeding among critically ill surgical patients are both important in the early postoperative period.

Materials And Methods: To record VTE prophylaxis prescribed for surgical patients in the intensive care unit (ICU) within the first postoperative week. We conducted a prospective observational cross-sectional study of Canadian university affiliated ICUs.

Proportional assist ventilation in acute respiratory failure: effects on breathing pattern and inspiratory effort.

Proportional assist ventilation (PAV) is a new mode of assisted ventilation which, by applying pressure in proportion to volume (volume assist, VA) and flow (flow assist, FA), should specifically reduce the inspiratory effort needed to overcome respiratory system elastance (Ers) and resistance (Rrs), respectively. The aims of this study were to determine (1) the effects of varying the level of VA on breathing pattern, inspiratory effort, and work of breathing, and (2) the interaction between VA and FA. In eight intubated patients with acute respiratory failure, four levels of VA (20 to 80% Ers) with and without a fixed amount of FA (approximately 50% Rrs) were evaluated.

Influence of site of tracheal pressure measurement on in situ estimation of endotracheal tube resistance.

In situ measurement of distal tracheal pressure (Ptr) via an intraluminal side-hole catheter (IC) has been used to determine endotracheal tube (Rett) and intrinsic patient (Rpt) resistances in intubated subjects. Because of differences in cross-sectional area between the endotracheal tube (ETT) and trachea, fluid dynamic principles predict that IC position should critically influence these results. Accordingly, the aim of this study was to determine the effect of IC position on Rett.

Absorbable fixation of first ray osteotomies.

A study was undertaken to evaluate the use of ORTHOSORB absorbable pin fixation for distal first ray osteotomies, in the management of hallux valgus. Data presented include 20 osteotomies fixated with ORTHOSORB absorbable pins in a crossing fashion, performed in 14 patients with an average follow-up period of 11 months. The patient population presented with an average age of 30, all were female.

Endothelin-1 in acute lung injury and the adult respiratory distress syndrome.

Endothelial damage is a hallmark of acute lung injury. Endothelial mediators may increase pulmonary vascular tone and induce pulmonary arterial muscularization, thereby contributing to the pulmonary hypertension seen with acute lung injury. We measured plasma levels and net pulmonary clearance of endothelin-1, a potent endothelium-derived vasoconstrictor peptide and smooth muscle mitogen, in 26 patients with early acute lung injury, the adult respiratory distress syndrome, and pulmonary hypertension.