High cost of stage IV pressure ulcers.

Background: The aim of this study was to calculate and analyze the cost of treatment for stage IV pressure ulcers.

Methods: A retrospective chart analysis of patients with stage IV pressure ulcers was conducted. Hospital records and treatment outcomes of these patients were followed up for a maximum of 29 months and analyzed.

Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America.

Objective: To update the practice parameters for the evaluation of adult patients who develop a new fever in the intensive care unit, for the purpose of guiding clinical practice.

Participants: A task force of 11 experts in the disciplines related to critical care medicine and infectious diseases was convened from the membership of the Society of Critical Care Medicine and the Infectious Diseases Society of America. Specialties represented included critical care medicine, surgery, internal medicine, infectious diseases, neurology, and laboratory medicine/microbiology.

Early versus late intravenous insulin administration in critically ill patients.

Objective: To investigate whether timing of intensive insulin therapy (IIT) after intensive care unit (ICU) admission influences outcome.

Design And Setting: Single-center prospective cohort study in the 14-bed medical ICU of a 1,171-bed tertiary teaching hospital.

Patients: The study included 127 patients started on ITT within 48 h of ICU admission (early group) and 51 started on ITT thereafter (late group); the groups did not differ in age, gender, race, BMI, APACHE III, ICU steroid use, admission diagnosis, or underlying comorbidities.

Utilization of bronchodilators in ventilated patients without obstructive airways disease.

Objective: To examine physician practice in, and the costs of, prescribing inhaled bronchodilators to mechanically ventilated patients who do not have obstructive lung disease.

Methods: This was a prospective cohort study at 2 medical intensive care units at 2 tertiary-care academic medical centers, over a 6-month period. Included were the patients who required > or = 24 hours of mechanical ventilation but did not have obstructive lung disease.

Effect of a convenient single 90-mg pamidronate dose on biochemical markers of bone metabolism in patients with acute spinal cord injury.

Background/objective: To describe the biochemical and adverse effects of a convenient single 90 mg pamidronate dose in patients with acute spinal cord injury (SCI) and compare these effects with those observed in a previous similar study using a 30 mg/d x 3-day pamidronate dosing regimen.

Study Design: Retrospective cohort study.

Setting: University-based rehabilitation center in New York City.

Improving medical student intensive care unit communication skills: a novel educational initiative using standardized family members.

Objective: To determine whether intensive care unit (ICU) communication skills of fourth-year medical students could be improved by an educational intervention using a standardized family member.

Design: Prospective study conducted from August 2003 to May 2004.

Setting: Tertiary care university teaching hospital.

Gonadal steroids in critical illness.

Gonadal steroids are metabolized in target cells and then interact with specific receptors to exert genomic and nongenomic effects. Complex feedback loops that involve the immune-neuroendocrine axis, limbic system, and gonadal steroids play a vital role in the adaptation to critical illness. Preclinical studies demonstrate adverse physiological effects of androgens on the cardiovascular and immune systems despite its purported anabolic effects.

Probability of mortality of critically ill cancer patients at 72 h of intensive care unit (ICU) management.

Goals: To develop and validate a model for probability of hospital mortality for cancer patients at 72 h of intensive care unit (ICU) management.

Patients And Methods: This is an inception cohort study performed at four ICUs of academic medical centers in the United States. Defined continuous and categorical variables were collected on consecutive patients with cancer admitted to the ICU.

Professionalism and the teaching of clinical medicine: perspectives of teachers and students.

Principles of medical professionalism include humanistic values, altruism, ethical and moral behavior, and a lifelong commitment to scholarship and learning. These principles can provide behavioral guidelines to residents, fellows and their teacher-physicians during the formative years of postgraduate training. This short paper presents some of the challenging professional questions raised during these years of training, where medical professionalism may help to guide us.

Pressure ulcers in the chronically critically ill patient.

All chronically critically ill patients are at high risk for development and progression of pressure ulcers. Constant surveillance including daily examination of the skin must be part of the care protocol. All pressure ulcers are chronic wounds that have an inherent, physiologic impairment to healing.

Critical illness neuromuscular abnormalities.

CINMAs occur commonly in acutely critically ill inflamed patients, and can prolong respiratory failure, lead to ventilator dependency, and contribute to the development of chronic critical illness. The etiology of NMDs are diverse and overlap, and distinguishing different disease entities by clinical exam and electrophysiologic studies can be difficult. CIP, which has been the most widely studied CINMA, represents the peripheral nervous system manifestation of the MODS.

A structure of care for the chronically critically ill.

The chronically critically ill (CCI) are complicated, labor-intensive, and costly patients to care for. A defined structure of care with different focuses at the beginning, middle, and end of a care episode may improve their outcomes and resource utilization. This article reviews the prediction of CCI, outlines some unifying processes of care during an episode of chronic critical illness, and explores some of the difficulties in defining consistent goals of care for this patient population.

Combined calcitriol-pamidronate therapy for bone hyperresorption in spinal cord injury.

Objective: To determine the biochemical effects of combined calcitriol-pamidronate therapy on bone hyperresorption in patients with spinal cord injury (SCI).

Methods: This was a retrospective study of 21 SCI inpatients (4 women and 17 men, mean age 34 years) treated for bone hyperresorption. Initial treatment was 0.

Identification of poor prognostic features among patients requiring mechanical ventilation after hematopoietic stem cell transplantation.

Patients who develop respiratory failure requiring mechanical ventilation after hematopoietic stem cell transplantation (HSCT) have very high mortality. Several investigators have identified prognostic features that can be used to identify a subset of these patients who are virtually certain to die, yet these have never been prospectively assessed. The objectives of this study were to determine the accuracy of published prognostic features for mortality and to determine the survival of patients who recover from respiratory failure.

Outcome prediction model for very elderly critically ill patients.

Context: Very elderly critically ill patients have three possible hospital outcomes: discharge to home, discharge to a skilled nursing or rehabilitation facility, or death. The factors associated with these outcomes are unknown.

Objective: To develop a three-outcome prediction model for very elderly critically ill patients.

Microscopic Pulmonary Tumor Emboli: An Unusual Presentation of Breast Cancer.

We report a rare case of microscopic pulmonary tumor embolism from breast cancer in a young woman with no prior medical history. The patient presented with progressive dyspnea and questionable abnormalities of the left breast and axilla on physical examination. Results of an axillary lymph node biopsy and subsequent radiologic studies raised the possibility of either microscopic pulmonary tumor emboli or lymphangitic spread of cancer as a cause of the dyspnea.

Self-reported symptom experience of critically ill cancer patients receiving intensive care.

Objective: To characterize the symptom experience of a cohort of intensive care unit (ICU) patients at high risk for hospital death.

Design: Prospective analysis of patients with a present or past diagnosis of cancer who were consecutively admitted to a medical ICU during an 8-month period.

Setting: Academic, university-affiliated, tertiary-care, urban medical center.

Biochemical response to treatment of bone hyperresorption in chronically critically ill patients.

Study Objective: The chronically critically ill (CCI) are a subgroup of critically ill patients who have survived an acute critical illness but remain profoundly debilitated and ventilator dependent. We have previously shown that CCI patients have a very high prevalence of bone hyperresorption. The objective of this present study was to determine the biochemical response of bone hyperresorption in CCI patients to treatment with either calcitriol alone or calcitriol and pamidronate.

Hypotestosteronemia in chronically critically ill men.

Objective: To determine the prevalence of hypotestosteronemia in chronically critically ill (CCI) men.

Design: Prevalence survey.

Setting: Step-down respiratory care unit (RCU) at a tertiary care teaching hospital.

Outcome for cancer patients requiring mechanical ventilation.

Purpose: To describe hospital survival for cancer patients who require mechanical ventilation.

Materials And Methods: A prospective, multicenter observational study was performed at five academic tertiary care hospitals. Demographic and clinical variables were obtained on consecutive cancer patients at initiation of mechanical ventilation, and information on vital status at hospital discharge was acquired.