Temperature monitoring in the intensive care unit

Close monitoring and management of temperature abnormalities are crucial in the critically ill to minimize the physiological and biochemical ill effects of extremes of temperature. In the intensive care unit, core temperature monitoring using either urinary, nasopharyngeal, or esophageal temperatures is recommended. One needs to be aware of the pitfalls and fallacies of other commonly used sites

Comparison of closed endotracheal suction versus open endotracheal suction in the development of ventilator-associated pneumonia in intensive care patients: An evaluation using meta-analytic techniques

Background : Ventilator-associated pneumonia (VAP), a frequent nosocomial infection in the intensive care, is associated with considerable morbidity. Endotracheal suctioning is routinely performed in mechanically ventilated patients to clear secretions. This study assessed if there were advantages of closed endotracheal suctioning (CES) over open endotracheal suctioning (OES) with respect to clinical outcomes. Materials and Methods : Trials comparing CES with OES were identified by search of MEDLINE® (1966-July 2006) and bibliographies of relevant articles. Only trials reporting VAP and/or mortality were considered. Studies reporting only physiological outcomes were excluded. Statistical Analysis Used : A meta-analysis of randomized controlled trials (RCTs) was performed using the random-effects estimator. The effect of suctioning type on VAP and mortality was reported as risk difference (RD) and duration of mechanical ventilation (MV) as mean weighted difference (MWD). Results : Nine RCTs fulfilled criteria for inclusion. There was no differential treatment effect of suctioning type (closed versus open, n = 9 studies) on VAP (RD - 0.01; 95% CI - 0.05, 0.03; P = 0.63) or on mortality (n = 5; RD 0.01; 95% CI - 0.04, 0.05; P = 0.8). Although OES was associated with a shorter duration of MV (n = 4; MWD -0.64; 95% CI 0.21, 1.06; P = 0.004), one study contributed significantly to the estimates. Heterogeneity of treatment effects was not observed. Conclusions : This meta-analysis has not demonstrated a superiority of CES over OES with respect to VAP or mortality. Thus the decision for the use of CES may be based on possible benefits in patients requiring high respiratory supports, reduced costs in those needing prolonged MV or occupational health and safety concerns with OES

Predictors of outcome in older adults admitted with sepsis in a tertiary care center

Background: Although there is increasing interest in exploring outcomes and predictors of outcomes of older adults who present with sepsis in developing countries, there is limited information from the low- and middle-income countries. Objective: This study was done to determine inhospital mortality and ascertain the factors predicting mortality among older inpatients with sepsis. Materials and Methods: This was a prospective observational study, from March 2018 to September 2019 in a tertiary care center in India. Baseline clinical, demographic, laboratory parameters and mortality were recorded from patients above the age of 60 years with a diagnosis of sepsis who were admitted to either the ward or intensive care unit (ICU). Logistic regression analysis was performed to determine predictors of inhospital mortality. Results: We found that 201 patients, predominantly male (64.6%) with a mean (standard deviation) age of 70.3 (7.8) years and a median (interquartile range) admission Sequential Organ Failure Assessment score of 5 (3–7), were admitted with sepsis. Lung infection was the most common source of sepsis (47.2%). Seventy-three patients (36.3%) required ICU admission, and inhospital mortality was 40.2%. Predictors of mortality included high Charlson Comorbidity Index (odds ratio [OR]: 1.3, 95% confidence interval [CI]: 1.1–1.6, P = 0.08), serum albumin (OR: 0.41, 95% CI: 0.20–0.80, P = 0.009), invasive mechanical ventilation (OR: 3.24, 95% CI: 1.2–8.9, P = 0.022), and the use of vasoactive agents (OR: 7.44, 95% CI: 2.8–19.9, P < 0.001). Blood culture positivity was found to have a survival benefit on Kaplan–Meier estimates. Conclusion: The mortality rate in older inpatients with sepsis was 40.2%. A high comorbidity burden, low serum albumin, and the need for invasive mechanical ventilation and vasoactive agents were independent predictors of mortality

Electrolytes assessed by point-of-care testing - Are the values comparable with results obtained from the central laboratory?

Background and Aims: When dealing with very sick patients, the speed and accuracy of tests to detect metabolic derangements is very important. We evaluated if there was agreement between whole blood electrolytes measured by a point-of-care device and serum electrolytes measured using indirect ion-selective electrodes. Materials and Methods: In this prospective study, electrolytes were analyzed in 44 paired samples drawn from critically ill patients. Whole blood electrolytes were analyzed using a point-of-care blood gas analyzer and serum electrolytes were analyzed in the central laboratory on samples transported through a rapid transit pneumatic system. Agreement was summarized by the mean difference with 95% limits of agreement (LOA) and Lin\u2032s concordance correlation (p c). Results: There was a significant difference in the mean (\ub1standard deviation) sodium value between whole blood and serum samples (135.8 \ub1 5.7 mmol/L vs. 139.9 \ub1 5.4 mmol/L, P &lt; 0.001), with the agreement being modest (p c = 0.71; mean difference -4.0; 95% LOA -8.78 to 0.65). Although the agreement between whole blood and serum potassium was good (p c = 0.96), and the average difference small (-0.3; 95% LOA -0.72 to 0.13), individual differences were clinically significant, particularly at lower potassium values. For potassium values &lt;3.0 mmol/L, the concordance was low (p c = 0.53) and the LOA was wide (1.0 to -0.13). The concordance for potassium was good (p c = 0.96) for values 653.0 (mean difference -0.2; 95% LOA -0.48 to 0.06). Conclusions: Clinicians should be aware of the difference between whole blood and serum electrolytes, particularly when urgent samples are tested at point of care and routine follow-up electrolytes are sent to the central laboratory. A correction factor needs to be determined at each center

Electrolytes assessed by point-of-care testing – Are the values comparable with results obtained from the central laboratory?

Background and Aims: When dealing with very sick patients, the speed and accuracy of tests to detect metabolic derangements is very important. We evaluated if there was agreement between whole blood electrolytes measured by a point-of-care device and serum electrolytes measured using indirect ion-selective electrodes. Materials and Methods: In this prospective study, electrolytes were analyzed in 44 paired samples drawn from critically ill patients. Whole blood electrolytes were analyzed using a point-of-care blood gas analyzer and serum electrolytes were analyzed in the central laboratory on samples transported through a rapid transit pneumatic system. Agreement was summarized by the mean difference with 95% limits of agreement (LOA) and Lin\u2032s concordance correlation (p c). Results: There was a significant difference in the mean (\ub1standard deviation) sodium value between whole blood and serum samples (135.8 \ub1 5.7 mmol/L vs. 139.9 \ub1 5.4 mmol/L, P &lt; 0.001), with the agreement being modest (p c = 0.71; mean difference -4.0; 95% LOA -8.78 to 0.65). Although the agreement between whole blood and serum potassium was good (p c = 0.96), and the average difference small (-0.3; 95% LOA -0.72 to 0.13), individual differences were clinically significant, particularly at lower potassium values. For potassium values &lt;3.0 mmol/L, the concordance was low (p c = 0.53) and the LOA was wide (1.0 to -0.13). The concordance for potassium was good (p c = 0.96) for values 653.0 (mean difference -0.2; 95% LOA -0.48 to 0.06). Conclusions: Clinicians should be aware of the difference between whole blood and serum electrolytes, particularly when urgent samples are tested at point of care and routine follow-up electrolytes are sent to the central laboratory. A correction factor needs to be determined at each center