Patients discharging the Intensive Care Unit (ICU) still need a high level of care because of the severity of their disease. In fact, they have an increased risk for readmission to the ICU. Moreover, urgent readmissions to the ICU are a widely used tool to assessment the quality of Health Care services. Although a lot of efforts are being made to reduce them, these adverse events still exist. It is noted that readmitted patients to the ICU have a much poorer prognosis, as its mortality rates are six times higher, and also have eleven times higher probability to die in hospital compared with other hospitalized patients.
Continue readingThe concept of sustainability in anesthesia, referred as "Environmentally Sustainable Anesthesia", can be characterized by the safe perioperative management of equipment and medicines by the anesthesiologist, without harming the environment. Τhe term "Green Anesthesia" also relates to the priority to environmental sustainability even if the economic factor comes second, but in essence, sustainable and green anesthesia refer to common actions and practices. The problem of environmental impacts from anesthesiology practice arises when managing chemical agents to ensure the proper conditions for safe anesthesia administration, by pharmaceutical means and special techniques. The main problem is the Inhaled agents (Ν2Ο and volatile anesthetics), as part of them is released into the atmosphere by forming Wasted Anesthetic Gases (WAGs). It begins in the operating room and ends into the atmosphere. Atmosphere is essential for life on earth.
Continue readingEurope is currently experiencing an unprecedented influx of refugees, asylum seekers and other migrants. More than 1.5 million people arrived in the European Union (EU) and European Economic Area (EEA) in 2015, fleeing countries affected by war, conflict or economic crisis. Member States are increasingly faced with the need to address the public health consequences of this massive arrival of migrants from various parts of the world, which puts national health systems under pressure.
Continue readingCurrent evidence suggests that the combination of fluid administration and vasoconstrictive medications should be the main strategy for prevention and management of hypotension accompanying neuraxial anesthesia procedures during cesarean section. Research is still underway in relation to the most appropriate timing for fluid administration, the most appropriate fluid volume as well as the type of fluid that should be administered.
Continue readingOne half of cortical thymoma patients develop myasthenia gravis (MG), an autoimmune disease affecting the voluntary muscles, while 15% of MG patients have thymomas. Thymectomy has been a mainstay in the treatment of myasthenia gravis and the management of such surgical patients is extremely demanding both at the physician’s and at the nurse’s level. In this paper we review some of the nursing interventions for patients with MG undergoing surgical removal of the thymus gland.
Continue readingBloodstream infections (BSIs) are a frequent and life threatening condition in hospital settings. The case fatality rate associated with BSI reaches 35-50% when associated with admission to intensive care unit (ICU). The extensive use of intravascular catheters, however, is recognized as the most important factor contributing to the occurrence of BSI. Catheter-related BSIs (CR-BSIs) are the most common types of BSI in ICU. Bacteraemias that occur in the ICU are classified as Community Onset BSI and Hospital Acquired (HA) BSI. They are also distinguished in primary and secondary. Community-onset BSIs are those that occur in outpatients or are first identified 48 h after admission to hospital/ICU, and they may be sub classified further as health care associated (HCA), when they occur in patients with significant prior health care exposure, or community associated, in other cases. Hospital Acquired (HA) and / or ICU-acquired BSIs are defined as those occurring more than 48 hours after the patient's admission into the hospital or ICU or within 48 hours of leaving the hospital or the ICU. Community acquired BSIs usually due to susceptible bacteria should be clearly differentiated from HCA and HA BSIs frequently due to resistant hospital strains. A bedridden status, presence of indwelling devices, recent hospitalization or contact with health care facilities and recent antibiotic therapy may represent the most important risk factors for the development of emerging multi drug resistant (MDR) GN infections. The basic components of the treatment of a bacteraemia in the ICU are determining the type of bacteraemia in order to target potential pathogens, the initiation of empirical antimicrobial therapy based on the guidelines, and the source control if it is a secondary bacteremia. These goals become difficult to achieve in case of BSI due to multi-drug resistant pathogens with high MICs to antimicrobials. The main mechanisms which have put in danger the marvelous antibiotic weapon are the production of ESBL (several different subtypes), the production of carbapenemases and metallo-betalactamases, with consequent spread of multi or pan-resistant organism and the emerging growing resistance in colistin. The targeted treatment should be applied immediately after receiving the susceptibility test from the cultures. Targeted treatment essentially consists in redefining antibiotic treatment, in de-escalation in order to decrease the antibiotic selection pressure, and in determining the duration of treatment. Source control is recognized as an important part of the therapy of BSIs and has been recently shown to be independently related with outcome. Depending on the source of the infection (pneumonia, CRBSIs, urinary tract infections, intra-abdominal infections), the therapeutic strategy should be based on international guidelines in combination with local microbiology and local antibiotic resistance data.
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