Red blood cell transfusion in paediatric critical care

Many children receive one or more units of red blood cell (RBC) preparations during their paediatric intensive care unit (PICU) admission depending on their underlying disease course. Physicians often justify RBC transfusions in critically ill children when anaemia is present because of the assumption that by increasing the haemoglobin level the delivery of oxygen (DO2) to peripheral tissues is improved so that ultimately the oxygen utilization (VO2) can be improved. However, the question whether or not the presence of anaemia in critically ill children is associated with adverse outcome cannot be answered easily. The TRIPICU study has clearly shown that it is safe to refrain from transfusing stable critically ill children unless their Hb has dropped below 7 g/dL (4.3 mmol/L) as increasing data emphasizes that the common practice of transfusing critically ill children is not free from causing harm as shown by increased morbidity and mortality. This narrative review summarizes the current literature and discusses possible pathophysiological mechanisms.     

Red blood cell transfusion therapy

This article describes the characteristics of alloantibodies associated with accelerated in vivo red cell destruction, pretransfusion tests performed to detect these antibodies, and the resolution of the incompatible crossmatch. Current transfusion practices, the indications for, and the complications of red cell transfusions are discussed.     

Fungal sepsis: optimizing antifungal therapy in the critical care setting

Invasive fungal infections (IFI) and fungal sepsis in the intensive care unit are increasing and are associated with considerable morbidity and mortality. In this setting, IFI are predominantly caused by Candida species. Outcomes continue to be suboptimal; however, there are a few key clinician modifiable factors. PK-PD studies with the approved antifungal agents have provided guidance on the dosing strategy that predicts improved outcome. In addition, time to therapy is a critical element. Therefore early recognition through improved risk factor analysis and diagnostics will be key developments. Source control for infected devices and endophthalmitis must be considered.     

Health care support workers in the critical care setting

The 1999/2000 winter demands on the NHS have once again highlighted deficits in UK critical care provision (Daily Telegraph, 2000; London Evening Standard, 2000) Recent years have seen the development of the role of health care support workers in the NHS; some critical care units now employ health care support workers This research examined the views of critical care unit staff on the introduction of health care support workers into the critical care unit It is concluded that the role is viable within the setting of this study A framework is outlined that could form the basis for a critical care health care support worker training programme     

Strategies for family-centered care in the critical care setting

Family-centered care (FCC) for critically ill or injured infants and children must be a priority for nurses and other health care professionals in the 1990s. Eight essential elements of FCC provide the basis for devising strategies for implementing FCC in the critical care setting.     

危重患者红细胞输注现状调查

目的 调查分析危重患者红细胞输注的合理性、真实效力以及与患者转归的关系.方法 回顾性调查2011年4～6月ICU 504名危重患者病历及输血资料,纳入标准为年龄≥18岁,以转出ICU或死亡作为研究终点.结果 危重病患者的红细胞输注合理率仅占33.9％,输血组与非输血组年龄构成比检验差异无统计学意义(x2=8.053,P＞0.05);输血组死亡率(34.5％)高于未输血组(12.5％),差异有统计学意义(x2=13.747,P＜0.05);输血组住ICU天数(14.5±16.4)d长于未输血组(6.7±10.3)d,差异有统计学意义(x2=50.645,P＜0.05);但本研究并未能排除患者的基础疾病状态等其它混杂因素对患者转归的影响,因此只能说明输血与患者转归有关,却不能证明因果联系.结论 输血与危重患者的转归相关,危重患者红细胞输注的合理性有待提高.     

Endotracheal drug administration in the critical care setting

Administration of drugs through an endotracheal tube has been evaluated in a number of animal models. In addition, the technique has been utilized in humans as reported in several published cases. A review of endotracheal drug administration with emphasis on application to the critical care setting is presented.     

Nursing leadership in the critical care setting.

The challenge of a nursing leadership role within the critical care setting is most unique in that two competencies are required--clinical and administrative talents. The development of such leaders also presents a challenge to administrators of health care settings. With administrative support of the nurse who aspires to such a role, we will continue to provide the caliber of care required by acutely ill and injured patients. Based on a philosophy of management that promotes both clinical and administrative talents, this plan will not only best serve the patient population of acute/critical care units but will also help foster the professional commitment of nurse practitioners and encourage them to aspire to such roles.     

Erythropoietin use in the critical care setting.

Biotechnology products signify a major advancement in our world today. Products resulting from biotechnology will revolutionize how health care is delivered. One of these technologic breakthroughs is recombinant human erythropoietin (epoetin). Its impact on the delivery of care to the anemic renal patient is changing the roles of nurses who provide care for these patients. Epoetin alfa has virtually eliminated the necessity of transfusions in the renal patient population, while simultaneously improving the quality of life for those patients and their families. To appropriately monitor the patient receiving epoetin therapy, the nurse must understand iron physiology and metabolism, factors that influence blood pressure, and factors that can blunt the response to epoetin therapy, and still appreciate the individual nursing requirements of each patient. Such juggling of information demands that the critical care nurse be alert to the subtle changes occurring within the patient, thereby allowing sound decisions based on astute nursing assessment.     

Malglycemia in the critical care setting. Part I: Defining hyperglycemia in the critical care setting using the glycemic ratio

IntroductionStress-induced hyperglycemia (SIH) is conventionally represented by Blood Glucose (BG) although recent evidence indicates the Glycemic Ratio (GR, quotient of mean BG and estimated preadmission BG) is a superior prognostic marker. We assessed the association between in-hospital mortality and SIH, using BG and GR in an adult medical-surgical ICU.MethodsWe included patients with hemoglobin A1c (HbA1c) and minimum four BGs in a retrospective cohort investigation (n = 4790).ResultsA critical SIH threshold of GR 1.1 was identified. Mortality increased with increasing exposure to GR ≥ 1.1 (r² = 0.94, p = 0.0007). Duration of exposure to BG ≥ 180 mg/dL demonstrated a less robust association with mortality (r² = 0.75, p = 0.059). In risk-adjusted analyses, hours GR ≥ 1.1 (OR 1.0014, 95%CI (1.0003–1.0026), p = 0.0161) and hours BG ≥ 180 mg/dL (OR 1.0080, 95%CI (1.0034–1.0126), p = 0.0006) were associated with mortality. In the cohort with no exposure to hypoglycemia however, only hours GR ≥ 1.1 was associated with mortality (OR 1.0027, 95%CI (1.0012–1.0043), p = 0.0007), not BG ≥ 180 mg/dL (OR 1.0031, 95%CI (0.9949–1.0114), p = 0.50) and this relationship remained intact for those who never experienced BG outside the 70-180 mg/dL range (n = 2494).ConclusionsClinically significant SIH commenced above GR 1.1. Mortality was associated with hours of exposure to GR ≥ 1.1 which was a superior marker of SIH compared to BG.