Use of a Portable Electronic Interface Improves Clinical Handoffs and Adherence to Lung Protective Ventilation.

Background: Mechanical ventilation (MV) is used to support patients with respiratory impairment. Evidence supports the use of lung-protective ventilation (LPV) during MV to improve outcomes. However, studies have demonstrated poor adherence to LPV guidelines.

Endotracheal Tube Fastening Device-Related Facial Pressure Ulcers.

Acute respiratory distress syndrome (ARDS) can be present in a substantial number of hospitalized Coronavirus disease 2019 (COVID19) disease patients. Some of these patients progress to severe ARDS and require mechanical ventilation. Patients requiring mechanical ventilation and intensive care unit (ICU) admission are at an increased risk of developing pressure ulcers from multiple medical devices used in their care.

Culture-Negative Septic Shock Compared With Culture-Positive Septic Shock: A Retrospective Cohort Study.

Objectives: To determine the clinical characteristics and outcomes of culture-negative septic shock in comparison with culture-positive septic shock.

Design: Retrospective nested cohort study.

Setting: ICUs of 28 academic and community hospitals in three countries between 1997 and 2010.

The efficacy of self-disinfecting bedrail covers in an intensive care unit.

Background: Hospital surfaces are considered important vectors in the spread of nosocomial pathogens. This study evaluated microbial counts on novel antimicrobial bedrail covers over a 2-week period in a critical care environment.

Methods: Disposable bedrail covers (Aionx Inc, Hershey, PA) made of a copper and silver polymer and capable of conducting an imperceptible surface potential, were installed in a case-control manner on a series of occupied intensive care unit beds.

Critical Care Organizations: Business of Critical Care and Value/Performance Building.

Objective: New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1). The goal of this article was to provide a roadmap and call attention to key factors that adult critical care medicine leadership in both academic and nonacademic setting should consider when planning for value-based care.

Utilizing bi-spectral index (BIS) for the monitoring of sedated adult ICU patients: a systematic review.

Background: The ideal level of sedation in the ICU is an ongoing source of scrutiny. At higher levels of sedation, the current scoring systems are not ideal. BIS may be able to improve both.

When is pneumonia not pneumonia: a clinicopathologic study of the utility of lung tissue biopsies in determining the suitability of cadaveric tissue for donation.

Healthcare-associated pneumonia (HCAP) represents a major diagnostic challenge because of the relatively low sensitivity and specificity of clinical criteria, radiological findings, and microbiologic culture results. It is often difficult to distinguish between pneumonia, underlying pulmonary disease, or conditions with pulmonary complications; this is compounded by the often-subjective clinical diagnosis of pneumonia. We conducted this study to determine the utility of post-mortem lung biopsies for diagnosing pneumonia in tissue donors diagnosed with pneumonia prior to death.

Biomarkers in Hepatic Disease: A Review Focused on Critically Ill Patients.

The ability to make a diagnosis early and appropriately is paramount for the survival of the critically ill ICU patient. Along with the myriad physical examination and imaging modalities available, biomarkers provide a window on the disease process. Herein we review hepatic biomarkers in the context of the critical care patient.

Implementing family communication pathway in neurosurgical patients in an intensive care unit.

Objective: Family-centered care provides family members with basic needs, which includes information, reassurance, and support. Though national guidelines exist, clinical adoption often lags behind in this area. The Geisinger Health System developed and implemented a program for reliable delivery of best practices related to family communication to patients and families admitted to the intensive care unit (ICU).

Family experience with intensive care unit care: association of self-reported family conferences and family satisfaction.

Purpose: A family conference is recommended as a best practice to improve communication in the intensive care unit (ICU), but this can be challenging given the setting. This study examined whether family members who reported that a family conference occurred had higher satisfaction than those who did not report that a conference was held.

Materials And Methods: The study used a retrospective data analysis of family satisfaction based on family member's responses to a questionnaire.

Case report of a transfusion-associated hepatitis A infection.

Background: Documented transfusion-associated hepatitis A (TAHA) is rare, and blood donors in the United States are not routinely screened for this infection. We report a case of TAHA associated with a donation made 8 days after a donor returned from a trip to South America.

Study Design And Methods: This is a review of donor and recipient records and a review of the literature.

Hospital-acquired infections and thermally injured patients: chlorhexidine gluconate baths work.

Background: Thermally injured patients are at high risk for infections, including hospital acquired infections (HAIs). We modeled a twice-daily chlorhexidine gluconate (CHG) bath protocol aimed at decreasing HAIs.

Methods: Bathing with a 0.

What we don't know may hurt us: urinary drainage system tubing coils and CA-UTIs-A prospective quality study.

Catheter-associated urinary tract infections account for >30% of infections in acute care hospitals. We hypothesized that coiling of/kinks in the indwelling urinary bladder catheter (IUBC) drainage bag tubing would increase the occurrence of infection/bacteriuria. Ninety-one patient events were evaluated over 60 days.

Decreasing ventricular infections through the use of a ventriculostomy placement bundle: experience at a single institution.

Object: Ventricular infection after ventriculostomy placement carries a high mortality rate. Responding to ventriculostomy infection rates, a multidisciplinary performance improvement team was formed, a comprehensive protocol for ventriculostomy placement was developed, and the efficacy was evaluated.

Methods: A best-practice protocol was developed, including hand hygiene before the procedure; prophylactic antibiotics; sterile gloves changed between preparation, draping, and procedure; hair removal by clipping for dressing adherence; skin preparation using iodine povacrylex (0.

The effect of increased mobility on morbidity in the neurointensive care unit.

Object: The detrimental effects of immobility on intensive care unit (ICU) patients are well established. Limited studies involving medical ICUs have demonstrated the safety and benefit of mobility protocols. Currently no study has investigated the role of increased mobility in the neurointensive care unit population.

Reduction of catheter-associated urinary tract infections among patients in a neurological intensive care unit: a single institution's success.

Object: To date, there has been a shortage of evidence-based quality improvement initiatives that have shown positive outcomes in the neurosurgical patient population. A single-institution prospective intervention trial with continuous feedback was conducted to investigate the implementation of a urinary tract infection (UTI) prevention bundle to decrease the catheter-associated UTI rate.

Methods: All patients admitted to the adult neurological intensive care unit (neuro ICU) during a 30-month period were included.

Noninvasive work of breathing improves prediction of post-extubation outcome.

Purpose: We hypothesized that non-invasively determined work of breathing per minute (WOB(N)/min) (esophageal balloon not required) may be useful for predicting extubation outcome, i.e., appropriate work of breathing values may be associated with extubation success, while inappropriately increased values may be associated with failure.

Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial.

Introduction: Most patients are readily liberated from mechanical ventilation (MV) support, however, 10% - 15% of patients experience failure to wean (FTW). FTW patients account for approximately 40% of all MV days and have significantly worse clinical outcomes. MV induced inspiratory muscle weakness has been implicated as a contributor to FTW and recent work has documented inspiratory muscle weakness in humans supported with MV.

Pressure support ventilation advisory system provides valid recommendations for setting ventilator.

Background: Pressure support ventilation (PSV) should be applied so that the inspiratory muscles are unloaded appropriately. We developed a computerized advisory system that assesses the load on the inspiratory muscles to spontaneously inhale, reflected by the automatically and noninvasively measured work of breathing per minute, and tolerance for that load, reflected by spontaneous breathing frequency and tidal volume, in a fuzzy-logic algorithm that provides recommendations for setting PSV. We call this a load and tolerance strategy for determining PSV.