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  1. Book ; Online ; E-Book: Hall, Schmidt and Wood's principles of critical care

    Schmidt, Gregory A. / Kress, John P. / Douglas, Ivor S.

    2023  

    Abstract: Hall, Schmidt and Wood's Principles of Critical Care is considered the field's definitive text. Principles of Critical Care offers unmatched coverage of the diagnosis and treatment of the most common problems encountered in the practice of critical care. ...

    Author's details Gregory A. Schmidt, John P. Kress, Ivor S. Douglas
    Abstract Hall, Schmidt and Wood's Principles of Critical Care is considered the field's definitive text. Principles of Critical Care offers unmatched coverage of the diagnosis and treatment of the most common problems encountered in the practice of critical care. Written by expert critical care physicians who are also experienced teachers, the book features an organization, thoroughness, and clarity not found in any other reference on the topic. Within its pages, you will find comprehensive, authoritative discussion of every aspect of critical care medicine essential to successful clinical practice, ranging from basic principles to the latest technologies.
    MeSH term(s) Critical Care. ; Intensive Care Units.
    Keywords Critical Care ; Intensive Care Units
    Subject code 616.02/8
    Language English
    Size 1 online resource :, ill., figs., tables.
    Edition Fifth ed.
    Publisher McGraw-Hill Education LLC
    Publishing place New York, N.Y
    Document type Book ; Online ; E-Book
    Remark Zugriff für angemeldete ZB MED-Nutzerinnen und -Nutzer
    ISBN 1-264-26435-6 ; 978-1-264-26435-3
    Database ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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  2. Article ; Online: Monitoring the venous circulation: novel techniques and applications.

    Longino, August A / Martin, Katharine C / Douglas, Ivor S

    Current opinion in critical care

    2024  Volume 30, Issue 3, Page(s) 260–267

    Abstract: Purpose of review: Venous pressure is an often-unrecognized cause of patient morbidity. However, bedside assessment of PV is challenging. We review the clinical significance of venous pressure measurement, existing techniques, and introduce the Venous ... ...

    Abstract Purpose of review: Venous pressure is an often-unrecognized cause of patient morbidity. However, bedside assessment of PV is challenging. We review the clinical significance of venous pressure measurement, existing techniques, and introduce the Venous Excess Ultrasound (VExUS) Score as a novel approach using doppler ultrasound to assess venous pressure.
    Recent findings: Studies show clear associations between elevated venous pressure and adverse outcomes in critically ill patients. Current venous pressure measurement techniques include physical examination, right heart catheterization (RHC), two-dimensional ultrasound, and a variety of labor-intensive research-focused physiological maneuvers. Each of these techniques have specific shortcomings, limiting their clinical utility. To address these gaps, Beaubien-Souligny et al. introduced the VExUS Score, a novel doppler ultrasound-based method that integrates IVC diameter with doppler measurements of the hepatic, portal, and renal veins to generate a venous congestion assesment. Studies show strong correlations between VExUS score and RHC measurements, and well as an association between VExUS score and improvement in cardiorenal acute kidney injury, diuretic response, and fluid status shifts. However, studies in noncardiac populations have been small, heterogenous, and inconclusive.
    Summary: Early studies evaluating the use of doppler ultrasound to assess venous congestion show promise, but further research is needed in diverse patient populations and clinical settings.
    MeSH term(s) Humans ; Ultrasonography, Doppler/methods ; Critical Illness ; Venous Pressure/physiology ; Vena Cava, Inferior/diagnostic imaging ; Vena Cava, Inferior/physiopathology ; Monitoring, Physiologic/methods ; Critical Care/methods
    Language English
    Publishing date 2024-03-28
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000001155
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  3. Article ; Online: Comments About Diabetes Insipidus After Discontinuation of Vasopressin Infusion for Treatment of Shock.

    Douglas, Ivor S

    Critical care medicine

    2020  Volume 48, Issue 3, Page(s) e256–e257

    MeSH term(s) Diabetes Insipidus ; Diabetes Mellitus ; Humans ; Vasopressins
    Chemical Substances Vasopressins (11000-17-2)
    Language English
    Publishing date 2020-02-10
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000004119
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  4. Article ; Online: Dynamic monitoring tools for patients admitted to the emergency department with circulatory failure: narrative review with panel-based recommendations.

    Douglas, Ivor S / Elwan, Mohammed H / Najarro, Marta / Romagnoli, Stefano

    European journal of emergency medicine : official journal of the European Society for Emergency Medicine

    2024  Volume 31, Issue 2, Page(s) 98–107

    Abstract: Intravenous fluid therapy is commonly administered in the emergency department (ED). Despite the deleterious potential of over- and under-resuscitation, professional society guidelines continue to recommend administering a fixed volume of fluid in ... ...

    Abstract Intravenous fluid therapy is commonly administered in the emergency department (ED). Despite the deleterious potential of over- and under-resuscitation, professional society guidelines continue to recommend administering a fixed volume of fluid in initial resuscitation. Predicting whether a specific patient will respond to fluid therapy remains one of the most important, but challenging questions that ED clinicians face in clinical practice. Surrogate parameters (i.e. blood pressure and heart rate), are widely used in usual care to estimate changes in stroke volume (SV). Due to their inadequacy in estimating SV, noninvasive techniques (e.g. bioreactance, echocardiography, noninvasive finger cuff technology), have been proposed as a more accurate and readily deployable method for assessing flow and preload responsiveness. Dynamic monitoring systems based on cardiac preload challenge and assessment of SV, by using noninvasive and continuous methods, provide more accurate, feasible, efficient, and reasonably accurate strategy for prediction of fluid responsiveness than static measurements. In this article, we aimed to analyze the different methods currently available for dynamic monitoring of preload responsiveness.
    MeSH term(s) Humans ; Hemodynamics/physiology ; Shock/diagnosis ; Shock/therapy ; Stroke Volume/physiology ; Resuscitation/methods ; Fluid Therapy/methods ; Emergency Service, Hospital ; Monitoring, Physiologic/methods
    Language English
    Publishing date 2024-02-16
    Publishing country England
    Document type Review ; Journal Article
    ZDB-ID 1233544-7
    ISSN 1473-5695 ; 0969-9546
    ISSN (online) 1473-5695
    ISSN 0969-9546
    DOI 10.1097/MEJ.0000000000001103
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  5. Article ; Online: Association of Hospital Mortality With Initiation of Mechanical Ventilation on a Weekend: A Retrospective Cohort Study.

    Rai, Karan / Douglas, Ivor S / Mehta, Anuj B

    Journal of intensive care medicine

    2023  Volume 38, Issue 12, Page(s) 1136–1142

    Abstract: Rationale: Increased mortality in patients admitted to hospitals on weekends is a well-described phenomenon labeled the "weekend effect." Studies evaluating the weekend effect in intensive care units (ICUs) have arrived at conflicting results. ... ...

    Abstract Rationale: Increased mortality in patients admitted to hospitals on weekends is a well-described phenomenon labeled the "weekend effect." Studies evaluating the weekend effect in intensive care units (ICUs) have arrived at conflicting results. Identifying a weekend effect for critically-ill patients may inform clinical care pathways and resource allocation.
    Objectives: Determine the association of initiation of mechanical ventilation (MV) upon admission on a weekend versus weekday with hospital mortality.
    Methods: We conducted a retrospective cohort study of non-surgical adult patients using the California Patient Discharge Database from 2018 to 2019. We identified MV initiated on the day of admission and diagnoses using discharge billing codes. The primary exposure was admission and initiation of MV on a weekend versus weekday and the primary outcome was hospital mortality. Hierarchical logistic regression was used to determine the association between hospital mortality and MV initiation timing, adjusting for case-mix.
    Results: Among 90 288 admissions in 2018 and 2019 meeting inclusion criteria, 24 771 (27.5%) had MV initiated on weekends, while 65 517 (72.6%) had MV initiated on weekdays. Patient demographics and comorbidities were similar between groups. Chronic alcohol and substance use disorders, and acute intoxications and traumas were more prevalent among patients with MV initiated on weekends. No difference in hospital mortality was observed with initiation of MV on weekends versus weekdays (23.1% vs 22.8%, ARD = 0.3%, aOR = 1.02, 95% CI 0.98, 1.07).
    Conclusions: Contrary to prior studies, no increased mortality was observed among newly admitted patients initiated on MV on weekends compared to weekdays. While weekend effects may exist in other settings, newly admitted patients likely have MV initiated in the emergency department or ICU, which tend to have more consistent staffing levels. Further research is needed to determine if care patterns in these units could be used as a model for units where weekend effects continue to impact outcomes.
    MeSH term(s) Adult ; Humans ; Retrospective Studies ; Patient Admission ; Hospital Mortality ; Respiration, Artificial ; Time Factors
    Language English
    Publishing date 2023-06-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632828-3
    ISSN 1525-1489 ; 0885-0666
    ISSN (online) 1525-1489
    ISSN 0885-0666
    DOI 10.1177/08850666231185315
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  6. Article ; Online: Misclassification of Safety Net Hospitals With National Data.

    Mehta, Anuj B / Douglas, Ivor S

    Chest

    2021  Volume 160, Issue 4, Page(s) e372–e373

    MeSH term(s) Hospitals ; Humans ; Medicaid ; Safety-net Providers
    Language English
    Publishing date 2021-10-01
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2021.05.060
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  7. Article ; Online: Pulmonary infections in critical/intensive care - rapid diagnosis and optimizing antimicrobial usage.

    Douglas, Ivor S

    Current opinion in pulmonary medicine

    2017  Volume 23, Issue 3, Page(s) 198–203

    Abstract: Purpose of review: Diagnosis of pulmonary infection, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in the critically ill patient remains a common and therapeutically challenging diagnosis with significant ... ...

    Abstract Purpose of review: Diagnosis of pulmonary infection, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in the critically ill patient remains a common and therapeutically challenging diagnosis with significant attributable morbidity, mortality, and cost. Current clinical approaches to surveillance, early detection and, conventional culture-based microbiology are inadequate for optimal targeted antibiotic treatment and stewardship. Efforts to enhance diagnosis of HAP and VAP and the impact of these novel approaches on rational antimicrobial selection and stewardship are the focus of recent studies reviewed here.
    Recent findings: Recent consensus guidelines for diagnosis and management of HAP and VAP are relatively silent on the potential role of novel rapid microbiological techniques and reply heavily on conventional culture strategies of noninvasively obtained (including endotracheal aspirate samples). Novel rapid microbiological diagnostics, including nucleic acid amplification, mass spectrometry, and fluorescence microscopy-based technologies are promising approaches for the future. Exhaled breath biomarkers, including measurement of VOC represent a future approach.
    Summary: Further validation of novel diagnostic technology platforms will be required to evaluate their utility for enhancing diagnosis and guiding treatment of pulmonary infections in the critically ill. However, the integration of novel diagnostics for rapid microbial identification, resistance phenotyping, and antibiotic sensitivity testing into usual care practice could significantly transform the care of patients and potentially inform improved targeted antimicrobial selection, de-escalation, and stewardship.
    Language English
    Publishing date 2017-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1285505-4
    ISSN 1531-6971 ; 1070-5287 ; 1078-1641
    ISSN (online) 1531-6971
    ISSN 1070-5287 ; 1078-1641
    DOI 10.1097/MCP.0000000000000366
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  8. Article ; Online: Utilization of Hospital Do-Not-Resuscitate Orders in Older Adults During COVID-19 Surges in 2020.

    Mehta, Anuj B / Douglas, Ivor S / Battaglia, Catherine / Wynia, Matthew K

    Journal of palliative medicine

    2023  Volume 27, Issue 2, Page(s) 201–208

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Humans ; Aged ; Resuscitation Orders ; Retrospective Studies ; COVID-19 ; Hospitals ; Hospitalization ; Hospital Mortality
    Language English
    Publishing date 2023-08-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1427361-5
    ISSN 1557-7740 ; 1096-6218
    ISSN (online) 1557-7740
    ISSN 1096-6218
    DOI 10.1089/jpm.2023.0277
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    Zs.A 5440: Show issues Location:
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  9. Article ; Online: Healthcare Trajectories and Outcomes in the First Year After Tracheostomy Based on Patient Characteristics.

    Mehta, Anuj B / Matlock, Daniel D / Shorr, Andrew F / Douglas, Ivor S

    Critical care medicine

    2023  Volume 51, Issue 12, Page(s) 1727–1739

    Abstract: Objectives: To define healthcare trajectories after tracheostomy to inform shared decision-making efforts for critically ill patients.: Design: Retrospective epidemiologic cohort study.: Setting: California Patient Discharge Database 2018-2019.: ...

    Abstract Objectives: To define healthcare trajectories after tracheostomy to inform shared decision-making efforts for critically ill patients.
    Design: Retrospective epidemiologic cohort study.
    Setting: California Patient Discharge Database 2018-2019.
    Patients: Patients who received a tracheostomy.
    Interventions: None.
    Measurements and main results: We tracked 1-year outcomes after tracheostomy, including survival and time alive in and out of a healthcare facility (HCF. Patients were stratified based on surgical status (did the patient require a major operating room procedure or not), age (65 yr old or older and less than 65 yr), pre-ICU comorbid states (frailty, chronic organ dysfunction, cancer, and robustness), and the need for dialysis during the tracheostomy admission. We identified 4,274 nonsurgical adults who received a tracheostomy during the study period with 50.9% being 65 years old or older. Among adults 65 years old or older, median survival after tracheostomy was less than 3 months for individuals with frailty, chronic organ dysfunction, cancer, or dialysis. Median survival was 3 months for adults younger than 65 years with cancer or dialysis. Most patients spent the majority of days alive after a tracheostomy in an HCF in the first 3 months. Older adults had very few days alive and out of an HCF in the first 3 months after tracheostomy. Most patients who ultimately died in the first year after tracheostomy spent almost all days alive in an HCF.
    Conclusions: Cumulative mortality and median survival after a tracheostomy were very poor across most ages and groups. Older adults and several subgroups of younger adults experienced high rates of prolonged hospitalization with few days alive and out of an HCF. This information may aid some patients, surrogates, and providers in decision-making.
    MeSH term(s) Humans ; Aged ; Cohort Studies ; Retrospective Studies ; Tracheostomy ; Frailty ; Multiple Organ Failure ; Renal Dialysis ; Delivery of Health Care ; Neoplasms
    Language English
    Publishing date 2023-08-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000006029
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    Zs.A 1261: Show issues Location:
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  10. Article ; Online: New diagnostic methods for pneumonia in the ICU.

    Douglas, Ivor S

    Current opinion in infectious diseases

    2016  Volume 29, Issue 2, Page(s) 197–204

    Abstract: Purpose of review: Pneumonia leading to severe sepsis and critical illness including respiratory failure remains a common and therapeutically challenging diagnosis. Current clinical approaches to surveillance, early detection, and conventional culture- ... ...

    Abstract Purpose of review: Pneumonia leading to severe sepsis and critical illness including respiratory failure remains a common and therapeutically challenging diagnosis. Current clinical approaches to surveillance, early detection, and conventional culture-based microbiology are inadequate for optimal targeted antibiotic treatment and stewardship. Efforts to enhance diagnosis of community-acquired and health care-acquired pneumonia, including ventilator-associated pneumonia (VAP), are the focus of recent studies reviewed here.
    Recent findings: Newer surveillance definitions are sensitive for pneumonia in the ICU including VAP but consistently underdetect patients that are clinically shown to have bacterial VAP based on clinical diagnostic criteria and response to antibiotic treatment. Routinely measured plasma biomarkers, including procalcitonin and C-reactive protein, lack sufficient precision and predictive accuracy to inform diagnosis. Novel rapid microbiological diagnostics, including nucleic-acid amplification, mass spectrometry, and fluorescence microscopy-based technologies are promising approaches for the future. Exhaled breath biomarkers, including measurement of volatile organic compounds, represent a future approach.
    Summary: The integration of novel diagnostics for rapid microbial identification, resistance phenotyping, and antibiotic sensitivity testing into usual care practice could significantly transform the care of patients and potentially inform significantly improved targeted antimicrobial selection, de-escalation, and stewardship.
    MeSH term(s) Biomarkers/analysis ; Breath Tests/methods ; Community-Acquired Infections/diagnosis ; Cross Infection/diagnosis ; Humans ; Intensive Care Units ; Microbiological Techniques/methods ; Microbiological Techniques/trends ; Molecular Diagnostic Techniques/methods ; Molecular Diagnostic Techniques/trends ; Pneumonia/diagnosis
    Chemical Substances Biomarkers
    Language English
    Publishing date 2016-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 645085-4
    ISSN 1473-6527 ; 1535-3877 ; 0951-7375 ; 1355-834X
    ISSN (online) 1473-6527 ; 1535-3877
    ISSN 0951-7375 ; 1355-834X
    DOI 10.1097/QCO.0000000000000249
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