Initial experience of therapeutic hypothermia after cardiac arrest with surface cooling method in Thammasat Chalerm Prakiat Hospital: two cases report.

OBJECTIVE: Therapeutic hypothermia is a recommended treatment by standard guidelines for patients after cardiac arrest but it is not distinguished in Thailand. The present report aimed to demonstrate feasibility of its use in Thailand. CASE REPORT: Two cases of patients after cardiac arrest treated with therapeutic hypothermia are reported. Surface cooling method with Arctic Sun system was applied in both cases. Core temperature curve and serial laboratory parameters are also reported. CONCLUSION: This initial experience of therapeutic hypothermia after cardiac arrest with surface cooling method implicates feasibility of its use in Thailand.

Initial inappropriate urinary catheters use in a tertiary-care center: incidence, risk factors, and outcomes.

OBJECTIVES: To evaluate the epidemiology and outcomes for initiation of inappropriate urinary catheterization (IUC) among hospitalized patients. SETTING: A 450-bed, tertiary-care hospital. PATIENTS: All patients admitted to the hospital from September 1, 2003 to June 12, 2004 with urinary catheter (UC). An independent observer reviewed the patient's chart, interviewed the patient and nursing staff, and assessed the need for the UC daily until the catheter was removed or the patient was discharged. RESULTS: One hundred thirty-one (15%) of 895 patients had initiation of IUC. The median age was 61 (range, 15-92). Medicine (0.52 catheter utilization ratio), surgery (0.24 catheter utilization ratio) and the ICUs (0.32) had the most UC use. Main reasons for initial IUC included no clear indication (28%), inappropriate urine output monitoring (26%), and urinary incontinence (18%). Admission to the medical ICU (adjusted odds ratio [aOR]=2.3; P<0.001), nonambulatory functional status (aOR=2.1; P<0.001), and female sex (aOR=1.9; P=0.001) were independently associated with IUC. Catheter-associated urinary tract infections (CA-UTI) occurred in 129 patients (14%). Patients with IUC had a longer duration of catheterization (12 vs. 3 days; P<0.01) were more likely to develop CA-UTI (82% vs. 8%; P=0.001) and had prolonged hospital length of stay (median, 15 vs. 5 days; P<0.001). The mean monthly cost of antibiotics for treatment of CA-UTI was $3480 (range, $1874-$5584). CONCLUSION: UC were inappropriately used more commonly among female, nonambulatory, and medical ICU patients. Careful attention to this aspect of medical care may reduce the incidence CA-UTI with subsequent decreases in length of stay, cost of hospitalization, and cost for treatment of CA-UTI.