... monitoring [43] In addition, several issues remain unanswered regarding continuous EEG recording inthe ICU, namely its exact indication, the required duration of monitoring, andthe clinical significance ... Chevrolet and Jolliet reducing pain, diminishing anxiety, inducing a better sleep rhythmicity, treating delirium, and so on) must be clearly defined in order to choose the appropriate drug Fourth, the ... on these drugs inthe ICU setting, and one study (MIND) is ongoing, comparing placebo, haloperidol and ziprazidone [57] 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Competing interests The...
... M.Sc 87 Managementand Treatment Amar Safdar, M.D and Issam I Raad, M.D 99 Catheter-Related InfectionsintheCriticallyIll vi TheManagementand Treatment of Intravascular Catheter-Related Infections ... CATHETER-RELATED INFECTIONSINTHECRITICALLYILL CATHETER-RELATED INFECTIONSINTHECRITICALLYILL Edited by Naomi P O’Grady, M.D Critical Care Medicine Department Warren Grant Magnuson Clinical ... regarding biofilms andthe role they play in catheter infections take on added significance when coupled with the extended dwell times of catheters xii Catheter-Related Infectionsinthe Critically...
... remain on the insertion site and to dry before inserting the catheter Allow povidone-iodine to remain on the skin for at least minutes, or longer if it is not yet dry before inserting the catheter ... Catheter-Related InfectionsintheCriticallyIll Site Dressings The importance of the cutaneous microflora inthe pathogenesis of CVCrelated infection suggests that the dressing applied to the ... technique during catheter insertion andin 14 Catheter-Related InfectionsintheCriticallyIll follow-up care of the catheter, have been associated with substantially lower rates of catheter-related...
... facilitated by the biofilm 34 Catheter-Related InfectionsintheCriticallyIll generated by the host and also by the production of adhesins and mucoid substances by the bacteria and fungi themselves ... controlled by inserting the subclavian catheters inthe operating room, by tunnelizing the subclavian lines, nor by improving skin antisepsis We then started a series of studies that included separate ... (14) Furthermore, the 28 Catheter-Related InfectionsintheCriticallyIll mechanisms and speed of S aureus migration along the subcutaneous tract have been investigated and clarified in an animal...
... PATHOGENESIS The two major pathways (extraluminal and intraluminal routes) involved inthe colonization of the catheter occur at different times during 60 Catheter-Related InfectionsintheCriticallyIll ... sterilely and placed in a sterile container with ml of phosphate buffered saline (PBS) The 52 Catheter-Related InfectionsintheCriticallyIll container is sonicated and vortexed The PBS is inoculated ... advances inthe diagnosis of catheter-related infection with the catheter in situ, confirmation of the diagnosis still requires either the removal of the catheter and clinical improvement of the patient...
... out the diagnosis of CRI, and surveillance skin cultures are not recommended 66 Catheter-Related InfectionsintheCriticallyIll Cultures of the catheter hub (Table 2), which explore mainly the ... catheters (44) Specific studies are needed to evaluate the validity of the technique incriticallyill patients with short-term catheters 70 Catheter-Related InfectionsintheCriticallyIllThe ... 64 Catheter-Related InfectionsintheCriticallyIll Comparison of Catheter Culture Techniques The different mechanisms of colonization of the intravascular part of the catheter may explain some...
... underlying illness (5-7,25) 94 Catheter-Related InfectionsintheCriticallyIll Relationship to Therapy The bulk of the studies reporting on use of antimicrobial therapy inappropriate for the ... rates and have thus been thought to be less deadly than secondary BSIs arising from a serious infection in another organ such as the lung The case report at the beginning of the chapter convincingly ... catheter (IV) was inserted into a vein in his hand while out inthe field This IV was left in place upon arrival to the hospital where he was found to have several broken ribs on the left and...
... 114 Catheter-Related InfectionsintheCriticallyIll There may be no obvious source of infection in a patient commonly with a low grade pyrexia and non-specific symptoms including chills and rigors ... antibiotic lock involves the administration of antibiotics which remain inthe internal lumen of the catheter for an extended period of time Intraluminal therapy has the advantages of directing the antimicrobial ... caused by Candida spp species other than Candida albicans, then amphotericin should be considered particularly inthe seriously ill 120 Catheter-Related InfectionsintheCriticallyIll patient...
... bloodstream infections, 15 to 29 clinical sepsis, and 15 to 32 vascular-access related infections Phillippe Eggimann and Didier Pittet 131 132 Catheter Related InfectionsintheCriticallyIll Phillippe ... of these infections (7) Catheter Related InfectionsintheCriticallyIll 136 CONCLUSIONS Inthe absence of other clinical focus of infection, vascular accesses are responsible for the majority ... Eggimann and Didier Pittet 133 134 Catheter Related InfectionsintheCriticallyIllTHE ST LOUIS EXPERIENCE More specifically designed to improve the handling of vascular accesses by the nursing...
... minocyline/rifampin catheter to the second-generation chlorhexidine/silver sulfadiazine catheter The decision to use chlorhexidine/silver sulfadiazine or minocycline/rifampin impregnated catheters ... prophylactic intervention to reduce the incidence of catheter-related infections One randomized study of hemodialysis catheters showed a reduction inthe incidence of exit site infections, catheter-tip ... 106–107 antibiotic lock therapy, 107 Catheter staining, in diagnosis of catheter infection, 46 Catheter types, rates of infection caused, Catheter-related infection incriticallyill diagnosis, 41–58,...
... patients inthe supine position first and turned them to the prone position after hours The other 13 patients were studied inthe prone position first and were then turned to the supine position The ... sedated inthe prone position but not inthe supine position The remaining four patients were not sedated in either position The mean cumulative dose of morphine/midazolam during hours inthe prone ... caloric intake Interruption of enteral feeding may lead to insufficient nutrition It is therefore important to know whether enteral feeding can be continued in a position other than the supine position...
... of illness at inception (within the first day of ICU admission) was assessed using the Acute Physiology and Chronic Health Evaluation (APACHE) II score [16] and intensity of care using the Therapeutic ... central laboratory and found them to be in good agreement [26] Inthe case of venous sampling we did not record whether they were obtained from central or peripheral sites In quantifying hyperlactatemia-days, ... Calgary and surrounding smaller cities (population 1.2 million) [13] Criticallyill adult patients inthe Calgary Health Region (CHR) are managed in closed ICUs under the care of certified intensivists...
... gastrointestinal bleeding (21, 3.2%), trauma (50, 6.6%), and operative gastrointestinal bleeding (15, 2.0%) The number of transfusions andthe age of RBCs are included in Table Age of RBCs and ... is therefore the first to assess the independent relationship between the age of RBCs and hospital mortality in a heterogeneous population of criticallyill patients Nonetheless, our findings ... have affected our findings The study comprised only Australian and New Zealand ICUs and its findings may not apply to other healthcare systems The transfusion practice andthe mean age of transfused...
... placing the hands at 10 and 11 rather than at 11 and 2, or they may fail the task completely Fold along this line to administer Cognitive Impairment inthe Elderly – Recognition, Diagnosis andManagement ... distributing the numbers properly, or whether the patient perseverates or forgets the task and continues numbering past 12 • Ask the patient to place hands on the clock showing the time to be 10 minutes ... an initial open-ended approach, e.g asking: “What you think the change in your memory and thinking is due to?” b In setting up the visit for disclosure, consider patient privacy and ask whether...
... to the introduction of efficient mechanisms for maintaining, updating, and searching routing tables, pro-active routing has been the most appealing approach inthe Internet Among the four combinations, ... intra-domain and inter-domain routing In inter-domain routing, however, a node inthe graph represents an AS An important problem with inter-domain policy routing is policy rule conflicts To illustrate ... [13] A routing and forwarding technique sometimes applied inthe Internet is source routing Source routing is a technique in which the source specifies the whole path to the destination inthe packet...
... anemia or in bleeding patients in whom RBC administration can increase both oxygen arterial content and cardiac output However, inthe absence of bleeding, the increase in hemoglobin concentration ... to the endothelium is increased, especially in septic patients, potentially leading to microcirculatory impairment and tissue hypoxia [13] Tolerance to anemia in healthy subjects andinthecritically ... hemoglobin or hematocrit trigger, and for the same level of hemoglobin, some patients will well, whereas others will not Thus, the decision to transfuse a patient should be individualized, taking into...
... shows the right gallbladder (see Fig 4.7), the inferior vena cava branch {R) pointing to the right, andthe left branch (L), (Fig 4.2) andthe aorta (Fig 4.1) also pointing to the right The walls ... simple and nontoxic, a great step forward will be made in abdominal ultrasonography A supine patient offers wide access to the abdomen, the lungs, the majority of the deep veins, the maxillary sinuses, ... on logic The first step is to define septic areas: the probe andthe cable, the keyboard, the lower part of the contact product bottle These areas will be distinct Prevention of cross-infections...
... the examination remains noncontributory, then and only then should a Doppler study be indicated Incriticallyill patients, mobile gas is sometimes observed inthe median and left hepatic veins, ... or In Summary heterogeneous, containing hyperechoic dots (could microlithiases be included inthe mass?) The inter- In conclusion, all these changes are routine and of face between the sludge and ... made using plain radiographs, which raises problems inthe supine patient CT is increasingly replacing plain radiographs Yet ultrasound can be highly helpful when showing the following at the bedside:...
... disk, the spinal canal andthe intervertebral foramen are well defined, forming the nose and eyes of the creature Depending on one's imagination, a gorilla inthe mist or one of the main characters ... familiar to the intensivist, and will then see in detail the subclavian vein, which we prefer for central venous access Internal Jugular Vein: Normal Pattern The internal jugular vein is recognized ... dotted lines Internal Jugular Vein Thrombosis 71 Fig 12.3 Normal internal jugular vein (V) in a longitu- Fig 12.4 A catheter is clearly identified within the dinal scan In this scan, the vein lies...