Search

Introduction. Inappropriate antibiotic therapy is responsible for the selection of multi-drug resistant strains and may pose a significant public health problem. During the COVID-19 pandemic, due to lack of evidence-based knowledge, the approach to antibiotic therapy varied between hospitals and predominantly depended on local protocols and individual physicians' decisions. The aim of this study was to assess antibiotic consumption during the COVID-19 pandemic compared to the pre-pandemic period in critically ill subjects in a tertiary intensive care unit (ICU). Methods. The annual changes in antibiotic consumption from 2018 until 2022 in a multidisciplinary ICU was analyzed retrospectively. Data on antibiotic consumption were obtained from the hospital pharmacy and calculated as daily defined dose (DDD) for individual groups of drugs. Results. During the pandemic period, fewer hospitalizations were observed, but they were longer. The overall antibiotic consumption in critically ill patients decreased compared to the pre-pandemic period. Among particular group of drugs, only aminoglycosides and clindamycin were prescribed more frequently. Conclusions. During COVID-19, the overall antibiotic consumption decreased, requiring further research to determine the reasons for this favorable trend. [ABSTRACT FROM AUTHOR]

Copyright of Social Work / Praca Socjalna is the property of Akademia Pedagogiki Specjalnej im Marii Grzegorzewskiej and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Polish Journal of Wound Management / Leczenie Ran is the property of Evereth Publishing Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The presented paper outlines the incidence of delirium tremens syndrome in intensive care units. It addresses the specificity of this qualitative consciousness disorder, the methods of its early diagnosis, as well as the principles of treatment and prevention. Furthermore, the significance of implementing a standardised procedure for assessing consciousness based on the RASS scale and the CAM-ICU worksheet has been indicated. [ABSTRACT FROM AUTHOR]

Blood gas analysis (BGA) is a part of basic laboratory work-up in patients hospitalized within emergency departments and intensive care units. Proper use and interpretation of BGA facilitate directed therapy in critically ill patients. This article summarizes the most relevant information regarding BGA laboratory profiles, reviews up--to-date literature, and investigates the utility of BGA in particular clinical scenarios. [ABSTRACT FROM AUTHOR]

Copyright of Paediatrics & Family Medicine / Pediatria i Medycyna Rodzinna is the property of Medical Communications Sp. z o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Intra-abdominal hypertension (IAH) is defined as an increase in intra-abdominal pressure (IAP) to =12 mmHg. When IAP >20 mmHg and organ failure develops, this condition is known as abdominal compartment syndrome (ACS). IAH/ACS are issues that combine the interests of many medical specialties. These clinical conditions are a common pathology in critically ill patients. IAH, being the most common symptom of abdominal organ dysfunction, becomes the cause of others itself, which is a part of the pathological mechanism of the vicious circle, affecting the work of organs located in other compartments of the body, giving the image of ACS. Many risk factors for IAH have been identified, most of which are modifiable. The current international recommendations recommend the measurement of intra-abdominal pressure in all patients at risk of IAH/ACS and define the basic diagnostic and therapeutic path for patients who develop this pathology. IAH prevention and appropriate treatment to avoid systemic complications are typical personalized procedures. [ABSTRACT FROM AUTHOR]

Delirium is a serious problem in critically ill patients. Its pathomechanism has been poorly recognized, and treatment is mainly based on clinical symptoms. This article presents a problem of delirium as well as its epidemiology, risk factors, pathomechanisms and frequently used diagnostic methods. The authors postulate to prevent delirium at the beginning of treatment including prevention of the most important risk factors. The non-pharmacological methods seem to be the best choice for treatment in critically ill patients with delirium. [ABSTRACT FROM AUTHOR]

Plasmapheresis is an extracorporeal blood purification technique in which plasma is separated from rest of the blood. Blood components causing harm can be selectively removed and substituted with adequate replacement fluid. This is an invasive procedure with a high incidence of adverse events although only few are serious. Patients admitted to Intensive Care Unit (ICU) with life threatening conditions including multiorgan failure may require implementation of advanced treatment methods including plasmapheresis. The American Society for Apheresis (ASFA) categorised and published indications for the use of therapeutic apheresis in human disease. In many clinical situations optimum role of apheresis therapy is not established and decisions should be individualized. Plasmapheresis does not directly treat underlying pathology although this may be employed to support other modes of treatment and may have a positive impact on patients' morbidity and mortality. This paper presents diseases in critically ill patients where plasmapheresis plays a role in the therapeutic strategy. [ABSTRACT FROM AUTHOR]

Intensive development of medicine in recent years has contributed to an increase in proportion of patients who survived despite critical illness and despite the need to treat their life-threatening condition in the intensive care unit (ICU). This allows teams taking care of the most demanding patients to concentrate on the quality of life of these people. Many patients suffer from mental disorders or impairment of physical and cognitive function after discharge from the ICU. These conditions cause limitations for returning to life from before treatment in ICU and are called Post-Intensive Care Syndrome (PICS). Symptoms related to emotions or mental state may also affect members of the family of a critically ill patient. Intensive care in Poland usually ends after the patient leaves ICU, therefore these symptoms often remain unrecognized and are not treated. Many of them can be counteracted already during treatment in the ICU. This article aims to present the characteristics of PICS, putting emphasis on problems of the patient and his family, also the possibility of further treatment after ICU discharge. [ABSTRACT FROM AUTHOR]

Sepsis associated delirium (SAD) is defined as diffuse brain damage caused by a systemic inflammatory response to infection, but without signs of central nervous system infection. This term replaced the term "septic associated encephalopathy" (SAE) used previously. The occurrence of ICU delirium in critically ill patients treated for generalized infection is associated with prolonged mechanical ventilation, time of hospitalization, long-term functional and cognitive impairment. A large amount of clinical data and research in the field of basic sciences indicate that inflammation of the nervous tissue, abnormal cerebral perfusion and disturbances in the balance of neurotransmitters are the main mechanisms underlying the development of SAD. There are no laboratory or electrophysiological tests or imaging studies or SAD-specific therapies, but this syndrome usually disappears after successful treatment of sepsis. After stabilizing the patient's condition, providing respiratory, cardiovascular and other organ support, and implementing effective treatment of infection, patients with severe sepsis or septic shock should undergo motor and cognitive rehabilitation as soon as possible because early onset may shorten the duration of the delirium. After establishing reliable and consistent definitions of SAD, it is necessary to conduct further studies explaining the pathophysiology of this condition and to develop dedicated methods of treatment. [ABSTRACT FROM AUTHOR]

The recent clinical trials have analysed correlation between procalcitonin level and choice of the antibiotic. Most of them concerned pulmonary infections and sepsis in critically ill patients. PCT was also evaluated in patients with suspected urinary tract infection, local wound infection and meningitis. The conclusion was that PCT level measured at hospital admission significantly delayed initiation of antibiotic therapy if the risk of infection was low. On the other side estimation of the PCT level allows to differentiate between COPD exacerbation and infection with subsequent antibiotic therapy. Regular assessment of PCT kinetics leads to earlier termination of the antibiotic therapy with no increase in risk of recurrent infections and unsuccessful outcome. It also does not increase mortality. Moreover, it has been demonstrated that PCT kinetics has prognostic value which correlates with severity of the disease. On the other hand, PCT has its limitations and laboratory testing should be correlated with clinical presentation. [ABSTRACT FROM AUTHOR]

Cardiac arrhythmias and electrocardiographic abnormalities are frequent complication in patients with cerebral injury. This relation is well known as "the brain-heart interaction". The precise patomechanisms of the brain-heart interaction have been still uncertain, however downregulation of autonomic nervous system, high blood stress hormone concentrations and general inflammatory response have been suggested as the most probably reason of brain-induced cardiac dysfunction. The main purpose of the present study was to analyse the brain-heart interaction in critically ill patients. [ABSTRACT FROM AUTHOR]

Copyright of Polish Nursing / Pielegniarstwo Polskie is the property of Poznan University of Medical Sciences Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Optimizing the time of implementation of renal replacement therapy (RRT) in critically ill patients is a widely discussed clinical problem. This paper presents the state of current knowledge on the subject, taking into account the results of the literature already published as well as a description of the ongoing research, the results of which may bring a response to emerging doubts. The early incorporation of RRT brings noticeable benefits. However, it cannot be said with full confidence that "early" RRT should be implemented in all AKI patients. It seems that we need to look deeper into specific, individual populations and clinical indications. Creatinine as a marker of kidney function is certainly not enough to make a binding decision. Perhaps the possibilities of using kidney damage biomarkers will broaden knowledge in this topic and help formulate more precise guidelines. [ABSTRACT FROM AUTHOR]

Intensive care units where complex treatment methods are used, including mechanical ventilation, have a higher risk of nosocomial infections acquired at this ward. The most common infection associated with mechanical ventilation is pulmonary inflammation (VAP). The aim of this study was to determine what microbiological factor influenced the occurrence of respiratory pneumonia in a patient hospitalized in the intensive care unit and it changed on individual days of hospitalization based on the value of the exponents of inflammation. The bacteriological agent that caused the occurrence of respiratory pneumonia in a patient hospitalized in the Department of Anesthesiology and Intensive Care was Acinetobacter baumannii. Symptoms of inflammation on particular days varied and influenced the patient's condition in a variable way. [ABSTRACT FROM AUTHOR]

Proper pressure ulcer prophylaxis reduces the occurrence of bed sores in patients with impaired overall health status. Circulatory and respiratory failure associated with patients hospitalized at the intensive care units (ICU) significantly increases the risk of pressure ulcers. Nursing care, the use of appropriate skincare products and mattresses or the way patients are fed, can dramatically reduce the number of pressure ulcers in ICU. [ABSTRACT FROM AUTHOR]

Critically ill patients with acute kidney injury in intensive care units are increasingly treated with continuous renal replacement therapy (CRRT). One of the major drawbacks of CRRT is frequent filter thrombosis. Reported filter lives vary between a few hours and a few days, and filter clotting has been held responsible for the majority of circuit terminations. Anticoagulation during CRRT should aim for an optimal filter performance allowing the delivery of an adequate dose of renal replacement therapy. The ideal anticoagulant for CRRT should prevent filter pozanaczyclotting without inducing haemorrhage, and should have a short half-life with action limited to the extracorporeal circuit. The continuous nature of the required anticoagulation results in prolonged exposure of the patient to anticoagulant, increasing the risk of haemorrhage and other side-effects. CRRT therapy without anticoagulation may result in acceptable filter lives in patients with reduced coagulatory potential or an increased risk of bleeding. Anticoagulation during CRRT should be individualized. The first goal of an anticoagulation management should be the safety of the patient. In patients with normal or moderately disturbed haemostasis and a moderate or absent risk of bleeding, an antithrombotic drug can be administered. Unfractionated heparin is still the most widely used anticoagulant during CRRT. [ABSTRACT FROM AUTHOR]

Unintentional hypothermia found in intensive care units may be a consequence of prehospital exposure to cold, serious injury but can also develop on the intensive care unit (ICU) itself or operating rooms. In many cases hypothermia is iatrogenic in nature and derives from the impaired thermoregulation induced by the action of drugs or medical treatment. Hypothermia has a complex effect on the body and causes a gradual, depending on the core temperature depression of virtually all organs and systems. For this reason, it may be an independent risk factor for death in patients hospitalized. Treatment of advanced forms of hypothermia should be carried out on intensive care units, where equipment and capabilities allow for the identification and control of all organ disorders. It is very important to prevent heat loss in patients undergoing surgery and to monitor the core temperature in patients who present with risk factors for development of hypothermia. The key is, however, a thorough knowledge of hypothermia for the correct assessment of the patient, the proper interpretation of the tests, prediction of potential complications, and use appropriate forms of therapy. [ABSTRACT FROM AUTHOR]

Postoperative pulmonary complications (PPCs) are common complications that increase morbidity and mortality rates after surgery, particularly among patients with pulmonary conditions. Preoperative evaluation of the risk for PPCs must take into account both patient-related and intraoperative risk factors. As a consequence of hypoventilation while impaired or abolished cough reflex takes place abounding airway secretions retention than in normal airway secretion volume, which rapidly disrupts the balance between overproduction of mucus and impaired clearance capabilities leading to bronchial obstruction and atelectasis. Atelectasis causes pulmonary blood shunting to increase and arterial blood hypoxaemia. Lung recruitment manoeuvres are ventilatory strategies that aim to restore the aeration of lungs. They consist of a brief and controlled increment in airway pressure to open up collapsed areas of the lungs and sufficient positive end-expiratory pressure (PEEP) to keep them open afterward. Atelectasis in critically ill mechanically ventilated patients is a common problem caused by a variety of mechanisms. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction Because the largest group of intensive care units (ICU) patients are unconscious and require mechanical ventilation of the lungs, hospitalization at ICU carries the risk of dangerous infections. Many invasive procedures can lead to complications, for example ventilator-associated pneumonia (VAP). Aim The aim of this study was to assess the level of knowledge that ICU nurses have on VAP and their role of VAP prevention. Material and methods The pilot study was carried out during a period of 60 days (from June 1st 2013 to July 31st 2013). 131 ICU nurses working at 7 different ICUs located around the Podkarpackie voivode- ship were enrolled into the study. The study was based on a survey prepared by the authors. Results The study demonstrated a correlation between prevention of VAP and the knowledge that nurses possessed. The older the nurses were and the more senior position they held, the more knowledge they possessed. Respondents with less experience, possessed less knowledge on the subject. Nurses involved in the study usually improved their qualifications through participation in specialized workshops and courses. Conclusions Nurses require regular training in accordance with current standards and guidelines. Unification of guidelines and protocols for VAP will contribute to the reduction in the risk of mechanical ventilation complications in patients treated in the ICU. Recommendations and guidelines for oral care and bronchial toilet need to be strictly followed. Developing and implementing uniform medical documentation standards for all ICUs in Poland would play a major role in the prevention of nosocomial infections. [ABSTRACT FROM AUTHOR]

Mechanical ventilation of the newborn after congenital esophageal atresia is extremely demanding, and its efficacy is important in the recovery process of the baby. Nursing requires assiduous attention, vigilance and careful neonatal care in accordance with the minimal handling principle. The aim of the study is to discuss the most important aspects of intensive neonatal therapy of a newborn with congenital esophageal atresia. [ABSTRACT FROM AUTHOR]

Mouth hygiene in pediatric intensive care is an important issue in terms of care and prevention of hospital-acquired infections, including infections related to mechanical ventilation. Its technique and the choice of the product should be adjusted to child's age and clinical status. Superficial plaque of both deciduous and permanent teeth is a source of pathogens, resulting in oropharyngeal colonization and increased risk of ventilator-associated pneumonia (VAP). [ABSTRACT FROM AUTHOR]

Atelectasis is one of the most commonly encountered abnormalities in patients undergoing general anaesthesia and in mechanically ventilated critically ill patients, treated in critical care units remaining a daily diagnostic challenge. Atelectasis describes loss of lung volume due to collapse of lung tissue. It can be classified according to: pathophysiologic mechanism, amount of lung involved and location. General anaesthesia induces ventilation/perfusion mismatch by lung collapse. Air retained distal to occlusion is resorbed from non-ventilated alveoli causing affected region to become totally airless and then collapse. Such lung collapse predisposes patients to postoperative complications. Atelectasis in critically ill mechanically ventilated patients is a common problem caused by a variety of mechanisms. The disorder is evident radiologically as an increase in density of the collapsed lung, with reduced volume of the involved hemithorax such as narrowed rib interspaces, elevated hemidiaphragm, and mediastinal shift to the side of involvement. Examination of a chest radiograph may be helpful to determine whether proximal or distal airway obstruction is involved. [ABSTRACT FROM AUTHOR]

Caring for the critically ill patient is a complicated process. It involves both doctors' and nurses' efforts. Clinical nutrition of intensive care unit (ICU) patients is necessary, because increased catabolism, caused by neuroendocrine changes and inflammatory reactions, may induce or worsen already existing malnutrition. In the case of patients with a functional gastrointestinal tract, the preferred route is enteral nutrition. Enteral nutrition maintains intestinal function and protects it from atrophy, subsequent bacterial translocation and septic complications. Parenteral nutrition should be implemented when enteral nutrition is insufficient, contraindicated or impossible. The improvement of ICU patients' outcome could be achieved by early nutritional support (enteral or/and parenteral) and glycemic control. Properly planned and conducted nutritional intervention can improve mortality, lower the number of complications and shorten the length of ICU and hospital stay. [ABSTRACT FROM AUTHOR]

Decubitus belonging to non-healing chronic wounds. They arise as a result of various internal and external causes. They are heal over 6 weeks. Mostly they occur in intensive care and anesthesia unit. The most important factors that cause damage to the skin and eventually rise to decubitus include: pressure, friction, movement type and humidity. The prevalence of decubitus in patients of intensive therapy requires making many complex and often expensive medical activities-beauty treatments. Furthermore, it is unpleasant and painful complication of immobilization of the patient. To prevention include: a risk assessment of the development of decubitus and focus on patients at risk for decubitus, skin care, changing body position, relief from oppressive places exposed to changes decubitus, nutrition and hydration, physiotherapy and documentation of actions taken. [ABSTRACT FROM AUTHOR]

Multidrug-resistant bacteria (MDR) are frequent cause of infections in hospitals around the world, which are very difficult to treat and control. The objective of the study was monitoring and evaluation of time and place of colonization by multidrug-resistant microorganisms of patients in the intensive care unit. We observed rapid colonization of respiratory tract and/or gastrointestinal tract by Klebsiella pneumoniae MDR and Acinetobacter baumannii MDR. In some cases, patients were colonized in the third day of stay in the ICU. Urinary tract and wounds were colonized later, over seventh day of stay in a hospital. We did not observe any colonization by MRSA and VRE. [ABSTRACT FROM AUTHOR]

Despite the great progress in medical care hospital-acquired infections (HAI) is still a concern of medical care units all over the world. HAI are one of the main causes of infectious diseases nowadays. These infections contribute to deterioration of patient's condition, increase of hospitalization time, and increase in hospitalization costs. The aim of the study is analysis of occurrence of selected hospital-acquired infections in critically ill patients with the view to answer the question whether and how occurrences of these infections can be minimized. Due to a vast scope of the subject, the analysis is focused on selected aspects, related to types of infections and preventive actions: hand hygiene and personal protection central venous catheter infections, moisture-associated skin damage prevention, ventilator-associated pneumonia, urinary tract infections, surgical site infections. Knowledge of and compliance with medical standards and procedures of conduct with regard to prevention of nosocomial infections contributes significantly to the reduction of infections. Education of medical personnel, as well as the cooperation and supervision of teams for infection control is of vital importance. [ABSTRACT FROM AUTHOR]

The immobilized patient is exposed to different medical complications and adverse effects. It is a daily task for the nursing team to maintain the proper personal hygiene of the immobilized patient. Due to the fact that it is a complicated procedure, it must be conducted according to the accepted order of washing certain parts of the body by using different and secure accessories for the personal hygiene, namely the bowls. A series of published studies show the relationship between the traditional bowls to wash the patients, and the transmission of pathogens to the patient. The hospital environment is said to be the reservoir for numerous pathogens which are responsible for the hospital-acquired infections (HAI) and the multiple-resistant ones. Thanks to a thorough observation, 1103 bowls and 88 hospitals from the USA and Canada have been microbiologically tested. Moreover, 62.2% of the examined bowls were infected by pathogens which caused a lot of nosocomial infections. The new standard proposal for the skin care of the immobilized patient includes the packages of towels to wash, moisturize and protect the skin of such a patient. This idea provides a patient with comfort, cleanliness and protection during the daily personal hygiene and in case of various periodic pollution. [ABSTRACT FROM AUTHOR]

Multidrug-resistant strains belonging to alert pathogens are a major cause of many serious and difficult to treat infections, which greatly increases the morbidity and mortality among ICU patients. Invasive procedures, high consumption of antibiotics in critically ill patients may explain the risk of the spread of these microorganisms in the ward. The article discusses the most important nosocomial pathogens such as multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, extended-spectrum beta-lactamases or carbapenemases producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus, vancomycin- resistant Enterococcus spp. and Clostridium difficile. [ABSTRACT FROM AUTHOR]

The article discusses how important is the mobility of the patient, the programme of early start in five steps, and how to improve the quality of the life of a patient who had the early start. [ABSTRACT FROM AUTHOR]

Lactate is the metabolic end-product of anaerobic glycolysis. In conditions of low flow or cellular hypoxia, pyruvate cannot enter the mitochondria and is preferentially reduced to lactate, causing blood lactate concentrations to increase. Lactate is produced in all tissues, but the greatest producers are skeletal muscle, brain, intestine, and red blood cells. During critical illness, increasing lactate production arises from the lungs, as well as white blood cells and splanchnic organs. Metabolism and clearance of lactate is primarily via the liver and kidneys, and dysfunction of these organs has been associated with varying levels of reduced clearance. Lactic acidosis occurs whenever production exceeds utilization and clearance. Type A lactic acidosis describes an inadequate oxygen delivery/consumption match and the presence of anaerobic glycolysis and type B lactic acidosis describes hyperlactatemia in the absence of anaerobic glycolysis, secondary to altered clearance, malignancy or drugs. [ABSTRACT FROM AUTHOR]