2011 November 10

Characterizing Glucose Changes Antecedent to Hypoglycemic Events in the Intensive Care Unit.

Nov 102011

Characterizing Glucose Changes Antecedent to Hypoglycemic Events in the Intensive Care Unit.

Endocr Pract. 2011 Nov 8;:1-23

Authors: Cook CB, Potter DJ, Kongable GL

Abstract
Objective: Little is known about the changes in glucose that occur leading up to hypoglycemia in the critically ill. We tested the hypothesis that patterns of glucose changes prior to hypoglycemia varied according to the severity of the event.Methods: Absolute glucose decrease (AGD), glucose rate of change (GROC), and glucose variability (GVAR) prior to hypoglycemic events (<40, 40-49, 50-59, and 60-69 mg/dL) were calculated. Comparisons were made to patients achieving a glucose range of 80 to 110 mg/dL without hypoglycemia.Results: A total of 128,419 point-of-care bedside glucose (POC-BG) measurements from 2,942 patients in 89 intensive care units were anlayzed. Patients who experienced the most severe hypoglycemic episodes had the largest absolute drop in their glucose levels prior to the event (P <.01). The GROC prior to a hypoglycemic event increased with worsening hypoglycemia: mean (SD) GROC was -1.69 (2.98) mg/dL/min prior an episode of <40 mg/dL, -0.56 (2.65) mg/dL/min prior to 60 to 69 mg/dL, but only -0.39 (0.70) for patients who attained a glucose range of 80 to 110 mg/dl without hypoglycemia (P <.01). GVAR prior to an event progressively increased with worsening biochemical hypoglycemia, and was least among persons achieving an 80 to 110 mg/dL range without hypoglycemia (P<.01).Conclusions: Antecedent glucose change and variability were greater for patients who experienced hypoglycemia. If monitored these patterns could potentially alert clinicians and help them take preventive measures. Further examination of how these parameters interact with other predisposing risk factors for hypoglycemia is warranted.

PMID: 22068252 [PubMed - as supplied by publisher]

Link to Article at PubMed

Herpes simplex virus encephalitis despite normal cell count in the cerebrospinal fluid.

Crit Care Med Start a Discussion »

Nov 102011

Herpes simplex virus encephalitis despite normal cell count in the cerebrospinal fluid.

Crit Care Med. 2011 Nov 3;

Authors: Jakob NJ, Lenhard T, Schnitzler P, Rohde S, Ringleb PA, Steiner T, Wildemann B

Abstract
OBJECTIVES:: To describe herpes simplex virus encephalitis despite normal cell count in the cerebrospinal fluid in patients with malignoma after whole brain irradiation. INTERVENTIONS:: Blood and cerebrospinal fluid analysis and magnetic resonance imaging. MEASUREMENTS AND MAIN RESULTS:: Three male and two female patients with malignoma and a recent history of whole-brain irradiation presented with impaired consciousness with or without epilepsy. Although cerebrospinal fluid analysis revealed a normal cell count, herpes simplex virus DNA was detected in all samples by polymerase chain reaction. CONCLUSIONS:: In patients with impaired consciousness, epileptic seizure, or temporal lobe symptoms of new onset and a recent history of brain irradiation with normal cerebrospinal fluid, an atypical anergic course of herpes simplex virus encephalitis should be considered. Herpes simplex virus polymerase chain reaction should be used as method of choice to detect herpes simplex virus genomes as early as possible rather than relying on routine cerebrospinal fluid parameters. Importantly, antiviral therapy should be started without delay in any case of faint suspicion and should be continued until herpes simplex virus encephalitis is clearly ruled out.

PMID: 22067626 [PubMed - as supplied by publisher]

Link to Article at PubMed

Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: A randomized controlled trial.

Crit Care Med Start a Discussion »

Nov 102011

Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: A randomized controlled trial.

Crit Care Med. 2011 Nov 3;

Authors: Wang W, Li HL, Wang DX, Zhu X, Li SL, Yao GQ, Chen KS, Gu XE, Zhu SN

Abstract
OBJECTIVES:: To evaluate the efficacy and safety of short-term low-dose intravenous haloperidol for delirium prevention in critically ill elderly patients after noncardiac surgery. DESIGN:: Prospective, randomized, double-blind, and placebo-controlled trial in two centers. SETTING:: Intensive care units of two large tertiary teaching hospitals. PATIENTS:: Four hundred fifty-seven patients 65 yrs or older who were admitted to the intensive care unit after noncardiac surgery. INTERVENTION:: Haloperidol (0.5 mg intravenous bolus injection followed by continuous infusion at a rate of 0.1 mg/h for 12 hrs; n = 229) or placebo (n = 228) was randomly administered from intensive care unit admission. MEASURES:: The primary end point was the incidence of delirium within the first 7 days after surgery. Secondary end points included time to onset of delirium, number of delirium-free days, length of intensive care unit stay, all-cause 28-day mortality, and adverse events. Delirium was assessed using the confusion assessment method for the intensive care unit. RESULTS:: The incidence of delirium during the first 7 days after surgery was 15.3% (35/229) in the haloperidol group and 23.2% (53/228) in the control group (p = .031). The mean time to onset of delirium and the mean number of delirium-free days were significantly longer (6.2 days [95% confidence interval, 5.9-6.4] vs. 5.7 days [95% confidence interval, 5.4-6.0]; p = .021; and 6.8 ± 0.5 days vs. 6.7 ± 0.8 days; p = .027, respectively), whereas the median length of intensive care unit stay was significantly shorter (21.3 hrs [95% confidence interval, 20.3-22.2] vs. 23.0 hrs [95% confidence interval, 20.9-25.1]; p = .024) in the haloperidol group than in the control group. There was no significant difference with regard to all-cause 28-day mortality between the two groups (0.9% [2/229] vs. 2.6% [6/228]; p = .175). No drug-related side effects were documented. CONCLUSIONS:: For elderly patients admitted to intensive care unit after noncardiac surgery, short-term prophylactic administration of low-dose intravenous haloperidol significantly decreased the incidence of postoperative delirium. The therapy was well-tolerated.

PMID: 22067628 [PubMed - as supplied by publisher]

Link to Article at PubMed

New insulins and insulin therapy.

Int J Clin Pract Start a Discussion »

Nov 102011

New insulins and insulin therapy.

Int J Clin Pract. 2011 Feb;65 Suppl 170:26-30

Authors: Danne T, Bolinder J

Abstract
The introduction of the so-called 'designer' insulins, the insulin analogues, has offered new opportunities in the clinical management of diabetes. Two additional new entities are close to reaching clinical practice. Linjeta™ (formally called VIAject) is not an analogue but rather a different formulation of human insulin which may give it a more rapid onset of action, potentially even faster than the currently available rapid-acting insulin analogues. Degludec™, on the other hand, is an insulin analogue molecule with an ultra-long clinical profile derived from the soluble multi-hexamer formation, resulting in a continuous slow and stable release of insulin degludec monomers which may last longer than currently available long-acting analogues. As with any new type of drug, the safety of the 'designer' insulins has to be closely scrutinised. Last year the increased cancer risk in diabetes entered the spotlight and the potential role of insulin analogues led to controversial discussions. In spite of recent new in vitro and observational data no new conclusive evidence became available. The need for multiple well-conducted and appropriately designed prospective observational studies to follow up the effectiveness and safety of the new insulins and the new insulin treatment regimens remains. In this chapter it was our mission to chose articles published about "new insulins" over the last year that have the most important contribution for the on-going development of ultra-fast- and ultra-long-acting insulin analogs and preparations and their potential side-effects, particularly cancer. This has been done by means of PubMed searches as well as a review of abstracts of the recent large international diabetes meetings such as ADA, EASD and ISPAD.

PMID: 21323810 [PubMed - in process]

Link to Article at PubMed

Hospitalists and intensivists in the medical ICU: A prospective observational study comparing mortality and length of stay between two staffing models.

J Hosp Med Start a Discussion »

Nov 102011

Hospitalists and intensivists in the medical ICU: A prospective observational study comparing mortality and length of stay between two staffing models.

J Hosp Med. 2011 Nov 8;

Authors: Wise KR, Akopov VA, Williams BR, Ido MS, Leeper KV, Dressler DD

Abstract
BACKGROUND: A shortage of critical care specialists or intensivists, coupled with expanding United States critical care needs, mandates identification of alternate qualified physicians for intensive care unit (ICU) staffing. OBJECTIVE: To compare mortality and length of stay (LOS) of medical ICU patients cared for by a hospitalist or an intensivist-led team. DESIGN: Prospective observational study. SETTING: Urban academic community hospital affiliated with a major regional academic university. PATIENTS: Consecutive medical patients admitted to a hospitalist ICU team (n = 828) with selective intensivist consultation or an intensivist-led ICU teaching team (n = 528). MEASUREMENTS: Endpoints were ICU and in-hospital mortality and LOS, adjusted for patient differences with logistic and linear regression models and propensity scores. RESULTS: The odds ratio adjusted for disease severity for in-hospital mortality was 0.8 (95% confidence interval [CI]: 0.49, 1.18; P = 0.23) and ICU mortality was 0.8 (95% CI: 0.51, 1.32; P = 0.41), referent to the hospitalist team. The adjusted LOS was similar between teams (hospital LOS difference 0.9 days, P = 0.98; ICU LOS difference 0.3 days, P = 0.32). Mechanically ventilated patients with intermediate illness severity had lower hospital LOS (10.6 vs 17.8 days, P < 0.001) and ICU LOS (7.2 vs 10.6 days, P = 0.02), and a trend towards decreased in-hospital mortality (15.6% vs 27.5%, P = 0.10) in the intensivist-led group. CONCLUSIONS: The adjusted mortality and LOS demonstrated no statistically significant difference between hospitalist and intensivist-led ICU models. Mechanically ventilated patients with intermediate illness severity showed improved LOS and a trend towards improved mortality when cared for by an intensivist-led ICU teaching team. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.

PMID: 22069304 [PubMed - as supplied by publisher]

Link to Article at PubMed

Characteristics and disease severity of healthcare-associated pneumonia among patients in a hospital in Kitakyushu, Japan.

j infect chemother Start a Discussion »

Nov 102011

Characteristics and disease severity of healthcare-associated pneumonia among patients in a hospital in Kitakyushu, Japan.

J Infect Chemother. 2011 Jun;17(3):363-9

Authors: Seki M, Hashiguchi K, Tanaka A, Kosai K, Kakugawa T, Awaya Y, Kurihara S, Izumikawa K, Kakeya H, Yamamoto Y, Yanagihara K, Tashiro T, Kohno S

Abstract
Healthcare-associated pneumonia (HCAP) is a newly identified condition, and epidemiologic studies in Japan are still limited. We retrospectively observed patients with HCAP and community-acquired pneumonia (CAP) who were hospitalized between December 2004 and March 2005, and compared their disease characteristics. A total of 34 patients (14 with HCAP and 20 with CAP) were evaluated. Of the patients with HCAP, seven (50%) were hospitalized for at least 2 days in the preceding 90 days and five (35.7%) resided in a nursing home or extended care facility. Compared with patients with CAP, patients with HCAP were older, had more complications, including central nerve diseases, had greater disease severity, but lower serum albumin level. More methicillin-resistant Staphylococcus aureus, Pseudomonas spp., and anaerobes were isolated from patients with HCAP than from those with CAP. Conversely, more Streptococcus pneumoniae was detected and more penicillin was used in patients with CAP. This study provides additional evidence that HCAP should be distinguished from CAP and suggests the pathogenesis and therapeutic strategy for HCAP may be similar to those for hospital-acquired pneumonia.

PMID: 20931256 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Older Entries

November 2011
M	T	W	T	F	S	S
« Oct				Dec »
	1	2	3	4	5	6
7	8	9	10	11	12	13
14	15	16	17	18	19	20
21	22	23	24	25	26	27
28	29	30