The path of least resistance: The unusual extradigestive journey of a nasogastric tube following oropharyngeal perforation.

Nasogastric tube placement is frequently performed in various medical settings. While generally deemed safe in patients without risk factors, complications may occur due to malposition, justifying the need of systematic confirmation of position with chest radiographs. We present the case of a critically ill male adult patient for whom the tube position was initially deemed very unusual on postinsertion radiographs, prompting further workup which ultimately confirmed an oropharyngeal perforation with a left parapharyngeal, left visceral, retrotracheal, and right retrodiaphragmatic course, and resulting in a recurrent pneumothorax and empyema treated by surgical decortication.

Albumin administration for fluid resuscitation in burn patients: A systematic review and meta-analysis.

Objective: The objective was to systematically review the literature summarizing the effect on mortality of albumin compared to non-albumin solutions during the fluid resuscitation phase of burn injured patients.

Data Sources: We searched MEDLINE, EMBASE and CENTRAL and the content of two leading journals in burn care, Burns and Journal of Burn Care and Research.

Study Selection: Two reviewers independently selected randomized controlled trials comparing albumin vs.

Intra-operative graft blood flow measurements for composite and sequential coronary artery bypass grafting.

Objectives: Intraoperative assessment of coronary artery bypass grafts (CABG) anastomotic quality can be performed using transit-time flowmetry (TTF). The aim of this study was to compare on- versus off-pump coronary graft TTF and early postoperative outcomes.

Materials And Methods: Between January 2009 and January 2010, 521 distal graft flows were assessed using TTF measurements in 253 consecutive patients undergoing primary isolated CABG surgery.

Hypoalbuminemia in the first 24h of admission is associated with organ dysfunction in burned patients.

Objective: Hypoalbuminemia is a common finding in burned patients, but its association with increased morbidity and mortality has not been well established. We assessed whether hypoalbuminemia in the first 24h of admission is associated with organ dysfunction in patients with severe burns.

Methods: For a two year period (2008-2009), we reviewed the records of burn adult patients with a total body surface area 20% admitted in our unit within the first 24h of injury.

Microcirculatory alterations in cardiac surgery: effects of cardiopulmonary bypass and anesthesia.

Background: Heterogeneity in microvascular perfusion is associated with impaired tissue oxygenation. We hypothesized that cardiac surgery with or without cardiopulmonary bypass (CPB) could induce microvascular alterations.

Methods: We used an orthogonal polarization spectral imaging technique to evaluate the sublingual microcirculation in patients undergoing cardiac surgery with (n = 9) or without (n = 6) CPB.

Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm.

Background: Percutaneous catheterization is a frequently-used technique to gain access to the central venous circulation. Inadvertent arterial puncture is often without consequence, but can lead to devastating complications if it goes unrecognized and a large-bore dilator or catheter is inserted. The present study reviews our experience with these complications and the literature to determine the safest way to manage catheter-related cervicothoracic arterial injury (CRCAI).

Pharmacokinetic variability of extended interval tobramycin in burn patients.

Background: Aminoglycosides are mandatory in the treatment of severe infections in burns. However, their pharmacokinetics are difficult to predict in critically ill patients. Our objective was to describe the pharmacokinetic parameters of high doses of tobramycin administered at extended intervals in severely burned patients.

Epidural anesthesia improves outcome and resource use in cardiac surgery: a single-center study of a 1293-patient cohort.

Thoracic epidural anesthesia (TEA) combined with general anesthesia in cardiac surgery has the potential to initiate earlier spontaneous ventilation and extubation, improved hemodynamics, less arrhythmia or myocardial ischemia, and an attenuated neurohormonal response. The aim of the current study was to characterize the correlation between TEA and postoperative resource use or outcome in a consecutive-patient cohort. The study was performed in a tertiary care, 3-surgeon, university-affiliated hospital that performs 350 to 400 cardiac surgeries per year.

Microvascular response to red blood cell transfusion in patients with severe sepsis.

Objectives: Microvascular alterations may play a role in the development of multiple organ failure in severe sepsis. The effects of red blood cell transfusions on microvascular perfusion are not well defined. We investigated the effects of red blood cell transfusion on sublingual microvascular perfusion in patients with sepsis.

Single rooms may help to prevent nosocomial bloodstream infection and cross-transmission of methicillin-resistant Staphylococcus aureus in intensive care units.

Objective: Nosocomial infections remain a major problem in intensive care units. Several authorities have recommended housing patients in single rooms to prevent cross-transmission of potential pathogens, but this issue is currently debated. The aim of the present study was to compare the rate of nosocomial cross-contamination between patients hosted in single rooms versus bay rooms.

Albumin administration improves organ function in critically ill hypoalbuminemic patients: A prospective, randomized, controlled, pilot study.

Objective: To test the hypothesis that administration of albumin to correct hypoalbuminemia might have beneficial effects on organ function in a mixed population of critically ill patients.

Design: : Prospective, controlled, randomized study.

Setting: Thirty-one-bed, mixed medicosurgical department of intensive care.

The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects.

Objective: To evaluate the effects of dobutamine on microcirculatory blood flow alterations in patients with septic shock.

Design: Prospective, open-label study.

Setting: A 31-bed, medico-surgical intensive care unit of a university hospital.

Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock.

Objective: To characterize the time course of microcirculatory alterations and their relation to outcome in patients with septic shock.

Design: Prospective, observational study.

Setting: Thirty-one-bed, medico-surgical intensive care unit in a university hospital.

Microvascular alterations in patients with acute severe heart failure and cardiogenic shock.

Background: Microvascular blood flow alterations may impair tissue oxygenation and may participate in the development of multiple organ failure in patients with severe heart failure. We hypothesized that microvascular blood flow alterations are present in patients with severe heart failure and cardiogenic shock.

Methods: We used an orthogonal polarization spectral imaging technique to investigate the sublingual microcirculation in 40 patients with acute severe heart failure, including 31 patients with cardiogenic shock, and in a control group of 15 patients who were examined the day before cardiac surgery.

Do all nonsurvivors of cardiogenic shock die with a low cardiac index?

Study Objectives: To characterize the hemodynamic course of cardiogenic shock and to relate the cause of death to ongoing cardiac failure or multiple organ dysfunction.

Design: Retrospective study.

Setting: A 31-bed department of intensive care in a university hospital.

15th Annual Congress of the European Society of Intensive Care Medicine, 29 September-2 October 2002, Barcelona, Spain: clinical research to improve outcome.

The 15Annual European Society of Intensive Care Medicine Meeting opened in Barcelona, Spain on September 30, 2002. This report focuses on some highlights of this congress. Preliminary data from the Sepsis Occurrence in the Acutely ill Patient (SOAP) study are presented, as are findings from the Assessment of Low Tidal Volume and Elevated End-Expiratory Volume to Obviate Lung Injury (ALVEOLI) study, which compared higher positive end-expiratory pressure (PEEP)/lower fractional inspired oxygen (FiO) with lower PEEP/higher FiOstrategies.

Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials.

Objective: To determine whether hypoalbuminemia is an independent risk factor for poor outcome in the acutely ill, and to assess the potential of exogenous albumin administration for improving outcomes in hypoalbuminemic patients.

Summary Background Data: Hypoalbuminemia is associated with poor outcomes in acutely ill patients, but whether this association is causal has remained unclear. Trials investigating albumin therapy to correct hypoalbuminemia have proven inconclusive.

Use of albumin in the intensive care unit.

Recent publications have renewed interest in albumin use in the ICU. Meta-analyses have been published that demonstrate the safety of albumin administration and even potential benefits. Hypoalbuminemia, which has long been considered a marker of disease, has been causally linked to the development of complications.

Delirium in critically ill patients.

Delirium in the intensive care unit is a serious problem that has recently attracted much attention. User-friendly and reliable tools, such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), offer the clinician the opportunity to identify delirium in patients better. Diagnosis of delirium in a critical care population is often a difficult task because classical psychiatric evaluation is impossible for a number of reasons.