Intensive care units incidence

Menon PA, Thach BT, Smith CH, et al. Benzyl alcohol toxicity in a neonatal intensive care unit. Incidence, symptomatology, and mortality. Am J Perinatal 1984 1(4) 288-292. 

Campbell, P.B., Bull, M.J., Ellis, F.D., Bryson, C.Q., Lemons, J.A. and Schreiner, R.C. (1983). Incidence of retinopathy of prematurity in a tertiary newborn intensive care unit. Arch. Ophthalmol. 101, 1686-1688. 

Patients admitted to the intensive-care unit (ICU) have severe pneumonia, and the etiology includes S. pneumoniae and H. influenzae as in the other categories however, the incidence of Legionella pneumophila increases in this setting and should be included in the organism differential. In addition, enteric gramnegative bacilli and S. aureus are more frequently the cause of the pneumonia. The recommendations are to treat with an... 

The incidence of septic shock has increased progressively during the past 50 years, so that it is now the most common cause of death in intensive care units (P4). Mortality from septic shock remains 30-60% despite considerable advances in... 

Chevret S., HemmerM., Carlet J., and Langer M. (1993) Incidence and risk factors of pneumonia acquired in intensive care units results from a multicenter prospective study on 996 patients. Intens. Care Med. 19, 256-264. 

Death due to the use or misuse of ketamine is rare. Only severe overdoses present substantial risk, and such incidents are usually treated in the intensive-care unit. The most dangerous effects of ketamine are behavioral. Individuals may become withdrawn, paranoid, and very uncoordinated. Physicians can only treat overdoses of this type symptomatically, by offering calm reassurance and an environment with little stimulation. 

Fluconazole is often given orally or i.v. to heavily immunocompromised patients (e.g. during periods of profound granulocytopenia) and to severely ill patients on intensive care units to reduce the incidence of systemic candidiasis. 

Procedure Beta-lactam desensitization should be done in an intensive care unit and any concomitant risk factors for anaphylaxis, such as use of beta-blockers should be corrected. Protocols based on incremental use of the drug orally or parenterally have been described (190,193). The oral route is preferable and is associated with a lower incidence of adverse events, but mild transient reactions are frequent (171,194,195). Pregnant women with limited antibiotic choices have been treated with immunotherapy (196). Repeated administration will maintain a state of anergy, which is often lost after withdrawal (197). At the conclusion of therapy, patients must be informed that after withdrawal, they may once again become allergic to penicillin, with a new reaction to the first subsequent application (197). 

Sepsis is the most frequent cause of AKI in intensive care units [78,79]. Moreover, when sepsis is associated with AKI the mortality increases dramatically [78]. The incidence of AKI increases even further in patients with septic shock. Also, the use of nephrotoxins e.g. aminoglycosides,, amphotericin B in septic patients may precipitate or worsen the AKI. 

Gruson, D. Hilbert, G. Vargas, F. Valentino, R. Bebear, C Allery, A. Bebear, C. Gbikpi-Benissan, G. Cardinaud, J.P. Rotation and restricted use of antibiotics in a medical intensive care unit. Impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistant gramnegative bacteria. Am. J. Respir. Crit. Care Med. 2000, 162 (3 Pt. 1), 837 843. 

ARF is a common condition in the general population, with an annual incidence of approximately 200 cases per million popnlationper year. The incidence rate is higher in hospitalized patients, 5% of whom may reqnire RRT (Table 42-1). The highest incidence of ARF is in hospitalized patients in the intensive care nnit. Depending on the definition nsed, ARF develops in 2% to 25% of patients in intensive care units. °... 

The incidence of hypocalcemia (total serum calcium less than 8.5 mg/dL) in intensive care unit patients ranges from 70% to 90% based on total, to 15% to 50% based on ionized calcium concentrations. Hypocalcemia is more commonly seen in hospitalized patients than in outpatients. 

One of the characteristics of critical illness is hypermetabolism. Trauma, burn injury, and sepsis are aU catalysts for the release of mediators that initiate and regulate the hypermetabohc response. The metabolic consequences of this response include altered carbohydrate metabolism, increased protein synthesis and degradation, and increased lipid oxidation, which ultimately result in loss of protein and lean body mass." In a previously well-nourished individual, critical illness can result in the onset of kwashiorkor-like malnutrition within 5 to 7 days. In a previously malnourished individual, critical illness can precipitate severe mixed marasmus-kwashiorkor in 3 to 5 days. In a prospective study of 129 patients admitted to the intensive care unit (ICU), 43% were malnourished." The malnourished patients had an increased length of stay in the ICU (a mean of 27 vs. 19 days) and a statistically significantly increased incidence of complications (55% vs. 40%) compared with well-nourished patients with a similar severity of illness. 

Clark RH, Wagner CL, Merritt RJ, et al. Nutrihon in the neonatal intensive care unit How do we reduce the incidence of extrauterine growth restriction J Perinatol 2003 23 337-344. 

A study from 1987 has measured the economic impact of aminoglycoside nephrotoxicity. This study had an incidence of nephrotoxicity of 7.3 %. There were 2.74 additional regular hospital days and 1.50 intensive care unit days. The average additional cost of this renal complication calculated over each course of prescribed therapy was US 2501 in 1987 [14]. With the inflation in medical costs this impact was already increased to US 4583 per case in 1997 [15] and can be calculated to US 6133 in 2002. 

This study used combination of methods including review of incident reports. ICU, intensive care unit PICU, paediatric intensive care unit. 

Once admitted to PICU, these children are of course much more likely to receive the treatment they need, but they then face other hazards recently mapped in a number of studies. In The Netherlands, Snijders and colleagues reviewed 4846 incident reports from 3859 admissions to neonatal intensive care units, the first speciality based study of locally reported incidents in these units. Medication and equipment problems dominated the reports though diagnostic issues, which are not usually well reported, were also frequent (Table 4.4). Significant patient harm was described in 70 of these reports ( 2% of admissions) ... 

Snijders, C., Kollen, B.J., van Lingen, R.A., Fetter, W.P.F., Molendijk, H. and Neosafe, S.G. 2009. Which aspects of safety culture predict incident reporting behavior in neonatal intensive care units A multilevel analysis. Critical Care Medicine, 37(1), 61-7. 

A study of the occurrence of critical incidents in an intensive care unit during the period 1989-1999 reported that most of the incidents were the result of staff errors and not equipment failures [19]. 

Wright, D., Critical Incident Reporting in an Intensive Care Unit, Report, Western General Hospital, Edinburgh, Scotland, UK, 2001. 

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