Browsing by Subject "Intensive Care Units"
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Item Relationship Between Clinical Rounding Practices and Patient Perception of Communication in the Intensive Care Unit (ICU)(2018-05) Stokes, Vanetria D.; Millar, J. Cameron; Gwirtz, Patricia A.; Mathew, Stephen O.In the neurosurgical intensive care unit (NSICU), families were being included in the medical rounds conducted by the healthcare team in an effort to improve communication options with family members who had patient family in the unit. As a result, simultaneous research was conducted. This research focused on perception of communication in the NSICU by patients. The study aimed to find if there are positive differences between patients whose families participated in rounds and families who did not participate in rounds. Using a 16-item survey this research problem was investigated in addition to patient preferences concerning how and if their families should be included in medical rounds. The study was considered a descriptive study design. The survey responses were scaled and were converted into numerical responses to assess results. The major finding for the study was that although many families did not attend rounds, patients still preferred that their family had the opportunity to participate. Also patients had a positive perception of their communication experience in the neurosurgical intensive care unit.Item Single-Center Analysis of Cardiogenic Shock Outcomes in the Cardiac ICU and Non-Cardiovascular ICU Setting(2023-12) Chenamsetty, Maneesha R.; Millar, J. Cameron; Ortega, SterlingCardiogenic shock (CS) is a complicated condition characterized by reduced cardiac output. Treatment methods for CS depend on the etiology and severity of CS. Despite the advanced treatment options CS still has a high mortality rate. In this project, we investigated the effect of intensive care unit (ICU) type on patients' CS clinical outcomes. A total of 133 patients were included from 2021-2023 admissions at Baylor University Medical Center (BUMC) hospital. The in-hospital mortality rate was higher in the non-cardiovascular ICU (NCICU) (48%) when compared to the cardiac ICU (CICU) (28%), and the difference was statistically significant (p<0.001). Patients admitted into the NCICU have highly unfavorable discharge locations (p= 0.03). The median duration of days spent in the CICU is significantly longer (p<0.001). These results may not conclude the effect of ICU type on outcomes, but it does influence the CS clinical outcomes.Item Variations of the lung microbiome and immune response in mechanically ventilated surgical patients(PLOS, 2018-10-24) Huebinger, Ryan M.; Smith, Ashley D.; Zhang, Yan; Monson, Nancy L.; Ireland, Sara J.; Barber, Robert C.; Kubasiak, John C.; Minshall, Christian T.; Minei, Joseph P.; Wolf, Steven E.; Allen, Michael S.Mechanically ventilated surgical patients have a variety of bacterial flora that are often undetectable by traditional culture methods. The source of infection in many of these patients remains unclear. To address this clinical problem, the microbiome profile and host inflammatory response in bronchoalveolar lavage samples from the surgical intensive care unit were examined relative to clinical pathology diagnoses. The hypothesis was tested that clinical diagnosis of respiratory tract flora were similar to culture positive lavage samples in both microbiome and inflammatory profile. Bronchoalveolar lavage samples were collected in the surgical intensive care unit as standard of care for intubated individuals with a clinical pulmonary infection score of >6 or who were expected to be intubated for >48 hours. Cytokine analysis was conducted with the Bioplex Pro Human Th17 cytokine panel. The microbiome of the samples was sequenced for the 16S rRNA region using the Ion Torrent. Microbiome diversity analysis showed the culture-positive samples had the lowest levels of diversity and culture negative with the highest based upon the Shannon-Wiener index (culture positive: 0.77 ± 0.36, respiratory tract flora: 2.06 ± 0.73, culture negative: 3.97 ± 0.65). Culture-negative samples were not dominated by a single bacterial genera. Lavages classified as respiratory tract flora were more similar to the culture-positive in the microbiome profile. A comparison of cytokine expression between groups showed increased levels of cytokines (IFN-g, IL-17F, IL-1B, IL-31, TNF-a) in culture-positive and respiratory tract flora groups. Culture-positive samples exhibited a more robust immune response and reduced diversity of bacterial genera. Lower cytokine levels in culture-negative samples, despite a greater number of bacterial species, suggest a resident nonpathogenic bacterial community may be indicative of a normal pulmonary environment. Respiratory tract flora samples were most similar to the culture-positive samples and may warrant classification as culture-positive when considering clinical treatment.