No abstract available.
Critical Illness*

No abstract available.
Critical Illness*

Objectives: The general objective was to compare the efficacy and safety of the Markovitz insulin protocol (MIP) with physician directed insulin infusion (PDI). Specific objectives were to compare the rate of change to normal glucose levels between MIP and PDP, time to achieve normal glucose levels and to determine the number of hypoglycemic episodes between MIP and PDI. Methodology: This is a retrospective study examining the medical records of critically ill patients admitted from 2001-2009. Efficacy outcome was measured as the time to achieve normal glucose level and the mean difference of percentage change towards normal blood glucose level. Safety outcome was measured in terms of frequency of hypoglycemic episodes. Results: One hundred and one patients met the inclusion criteria. The mean time required to achieve target blood glucose levels was 24 hrs (SD=19.5) for MIP compared to PDI. The mean drop in blood glucose levels was -235.49 (SD=113.4), with mean percent difference of -57.5% (SD=20.72) (p-value = 0.919) for MIP compared to physician directed. The MIP resulted in a higher percentage of blood glucose within target (19.57% vs 9.86 %) compared to PID (p= 0.005). Patients in MIP had shorter ICU stay (p=0.049). In addition, MIP was associated with a significantly lower rate of hypoglycemia at 4.2%, compared to PID at 30% (p<0.001). Conclusions Markovitz insulin protocol appeared to be significant to physician directed insulin infusion in terms of its greater percentage of glucose measurements maintained within target range, without an increased risk of severe hypoglycemia.
Critical Illness

Careful nutritional strategy is an essential component in the management of critically ill patients. Evidence-based clinical practice guidelines can be an effective solution to improving the process and structure of nutritional strategy for critically ill patients. The 2015 Canadian clinical practice guidelines (CPGs) summarized the evidence from approximately 354 randomized controlled trials in the area of critical care nutrition since 1980. The Canadian CPGs were first developed in 2003 and have been updated every 2 years. It is important for the acquisition of new evidence-based knowledge. This paper includes a brief summary on changes in 2015 CPGs compared with 2013 CPGs.
Critical Care ; Critical Illness ; Humans

No abstract available.
Critical Illness* ; Nursing*

No abstract available.
Critical Illness ; Humans ; Hydrocortisone

No abstract available.
Critical Illness* ; Lung* ; Ultrasonography*

No abstract available.
Critical Illness* ; Hemofiltration* ; Humans

Measurement of peak flow rate (PER) is useful to assess venilatory capacity of a critically ill patient and particulary in the evaluation of obstructive ventilatory disease because of it easy management. A number of studies have already shown the usefulness of PFR measurement for rapid determination of pumonary reserve, for preoperative assement of pulmonary function or in evaluating changes in patient's degree of pulmonary disability. In view of the close correlation between PFR & MBC(Maximal breathing capacity) peak flow determination should also be of value in patients in whom the MBC cannot be measured easily because of the patient's illness or lack of sustained cooperation. In this study, the correlation coefficient (r) was found to be 0.77 between PFR & MBC, 0.72 between PFR & FEV1(forced expiratory volume for one second) and 0.73 between PFR & VC(vital capacity). Therefore we think that the measurement of peak flow rate in detecting ventilatory disease or in following a patient's ventilatory capacity is recommended.
Critical Illness ; Humans ; Respiration

Introduction. A significant number of critically ill patients, as high as 60% among patients with septic shock, suffer from critical illness-related corticosteroid insufficiency (CIRCI), which refers to an inadequate corticosteroid response to the level of stress.

Objectives. This study aimed to determine the strategies employed in managing patients with critical illness-related corticosteroid insufficiency and the outcomes of these patients at a tertiary hospital.

Methods. This was a single-center, mixed-methods study which consisted of a review of charts of patients 19 years old and above admitted for shock or developed refractory hypotension from January 2017-December 2019, and key informant interviews and focus group discussion among clinicians who have experience in managing CIRCI.

Results. A total number of 362 patient charts reviewed showed a relatively low rate of initiation of corticosteroids for patients with refractory shock, at just 28.57% of the entire population. After corticosteroids were initiated, patients were in shock for a median of just one day and the median blood pressure improved to 100/60 mm Hg. In this cohort, patients who were started on steroids had more severe illness, as measured by the Mortality Probability Model (MPM) score, which had a median of 43.65% for the group on steroids and just 25.0% for the non-steroid group (p ? 0.0001). Patients who were started on steroids had a statistically significant longer median days on a ventilator, 5 days vs. 3 days for the non-steroid group (p = 0.0297); longer median length of intensive care unit (ICU) stay, 8 days vs. 5 days for the non-steroid group (p = 0.0410), and a higher morbidity and mortality rate. The need for steroids, the presence of septic shock, and a higher MPM score were significant predictors of mortality.

Discussions among clinicians revealed significant variability in practices in the management of CIRCI.

Conclusion. The presence of clinical features of CIRCI is a poor prognostic factor. Timely recognition, work-up, and interventions to address CIRCI are paramount in critical care.