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Critical Care Medicine

Vincent X Liu, Gabriel J Escobar, Rakesh Chaudhary, Hallie C Prescott
OBJECTIVES: To quantify healthcare utilization in the week preceding sepsis hospitalization to identify potential opportunities to improve the recognition and treatment of sepsis prior to admission. DESIGN: Retrospective study. SETTING: Two large integrated healthcare delivery systems in the United States. PARTICIPANTS: Hospitalized sepsis patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We quantified clinician-based encounters in each of the 7 days preceding sepsis admission, as well as on the day of admission, and categorized them as: hospitalization, subacute nursing facility, emergency department, urgent care, primary care, and specialty care...
January 5, 2018: Critical Care Medicine
Elsa Juan, Marzia De Lucia, Valérie Beaud, Mauro Oddo, Marco Rusca, Dragana Viceic, Stephanie Clarke, Andrea O Rossetti
OBJECTIVES: To show that subjective estimate of patient's condition is related to objective cognitive and functional outcome in cardiac arrest survivors. DESIGN: Longitudinal cohort study. SETTING: ICU and Neuropsychology Service in two hospitals in Switzerland. PATIENTS: Fifty survivors included from a prospective cohort of 138 patients admitted at the ICU for cardiopulmonary arrest. INTERVENTIONS: Comprehensive cognitive and functional evaluation at 6 months follow-up...
January 5, 2018: Critical Care Medicine
Mark J W McPhail, Francesca Parrott, Julia A Wendon, David A Harrison, Kathy A Rowan, William Bernal
OBJECTIVE: To assess the epidemiology and outcome of patients with cirrhosis following critical care unit admission. DESIGN: Retrospective cohort study. SETTING: Critical care units in England, Wales, and Northern Ireland participating in the U.K. Intensive Care National Audit and Research Centre Case Mix Programme. PATIENTS: Thirty-one thousand three hundred sixty-three patients with cirrhosis identified of 1,168,650 total critical care unit admissions (2...
January 5, 2018: Critical Care Medicine
Kosuke Kuroda, Hidenori Wake, Shuji Mori, Shiro Hinotsu, Masahiro Nishibori, Hiroshi Morimatsu
OBJECTIVES: Many biomarkers for sepsis are used in clinical practice; however, few have become the standard. We measured plasma histidine-rich glycoprotein levels in patients with systemic inflammatory response syndrome. We compared histidine-rich glycoprotein, procalcitonin, and presepsin levels to assess their significance as biomarkers. DESIGN: Single-center, prospective, observational cohort study. SETTING: ICU at an university-affiliated hospital...
January 4, 2018: Critical Care Medicine
Vignan Yogendrakumar, Eric E Smith, Andrew M Demchuk, Richard I Aviv, David Rodriguez-Luna, Carlos A Molina, Yolanda Silva Blas, Imanuel Dzialowski, Adam Kobayashi, Jean-Martin Boulanger, Cheemun Lum, Gord Gubitz, Vasantha Padma, Jayanta Roy, Carlos S Kase, Rohit Bhatia, Myzoon Ali, Patrick Lyden, Michael D Hill, Dar Dowlatshahi
OBJECTIVES: There are limited data as to what degree of early neurologic change best relates to outcome in acute intracerebral hemorrhage. We aimed to derive and validate a threshold for early postintracerebral hemorrhage change that best predicts 90-day outcomes. DESIGN: Derivation: retrospective analysis of collated clinical stroke trial data (Virtual International Stroke Trials Archive). VALIDATION: retrospective analysis of a prospective multicenter cohort study (Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign [PREDICT])...
January 4, 2018: Critical Care Medicine
Alistair E W Johnson, Jerome Aboab, Jesse D Raffa, Tom J Pollard, Rodrigo O Deliberato, Leo A Celi, David J Stone
OBJECTIVES: To evaluate the relative validity of criteria for the identification of sepsis in an ICU database. DESIGN: Retrospective cohort study of adult ICU admissions from 2008 to 2012. SETTING: Tertiary teaching hospital in Boston, MA. PATIENTS: Initial admission of all adult patients to noncardiac surgical ICUs. INTERVENTIONS: Comparison of five different algorithms for retrospectively identifying sepsis, including the Sepsis-3 criteria...
January 4, 2018: Critical Care Medicine
Hanane Hireche-Chikaoui, Martin R Grübler, Andreas Bloch, Stephan Windecker, Stefan Bloechlinger, Lukas Hunziker
OBJECTIVES: Cardiogenic shock constitutes the final common pathway of cardiac dysfunction associated with tissue hypoperfusion and organ failure. Besides treatment of the underlying cause, temporary mechanical circulatory support serves as a supportive measure. Extracorporeal membrane oxygenation can effectively prevent hypoxemia and end-organ dysfunction, but knowledge about patient selection, risks, and complications remains sparse. DATA SOURCES: Clinical observation...
January 4, 2018: Critical Care Medicine
Urs Weber, Jennifer Johnson, Nathanial Anderson, Andrea K Knies, Belinda Nhundu, Cynthia Bautista, Kevin B Huang, Muhammad Hamza, Jessica White, Anna Coppola, Kathleen M Akgün, David M Greer, Evie G Marcolini, Emily J Gilmore, Nils H Petersen, Nona Timario, Kelly Poskus, Kevin N Sheth, David Y Hwang
OBJECTIVE: It was hypothesized that adding dedicated afternoon rounds for patients' families to supplement standard family support would improve overall family satisfaction with care in a neuroscience ICU. DESIGN: Pre- and postimplementation (pre-I and post-I) design. SETTING: Single academic neuroscience ICU. PATIENTS: Patients in the neuroscience ICU admitted for longer than 72 hours or made comfort measures only at any point during neuroscience ICU admission...
January 3, 2018: Critical Care Medicine
Nareg H Roubinian, Jeanne E Hendrickson, Darrell J Triulzi, Jerome L Gottschall, Michael Michalkiewicz, Dhuly Chowdhury, Daryl J Kor, Mark R Looney, Michael A Matthay, Steven H Kleinman, Donald Brambilla, Edward L Murphy
OBJECTIVES: Transfusion-associated circulatory overload is characterized by hydrostatic pulmonary edema following blood transfusion. Restrictive transfusion practice may affect the occurrence and severity of transfusion-associated circulatory overload in critically ill patients. We sought to examine contemporary risk factors and outcomes for transfusion-associated circulatory overload. DESIGN: Case-control study. SETTING: Four tertiary care hospitals...
January 3, 2018: Critical Care Medicine
Lisiane Pruinelli, Bonnie L Westra, Pranjul Yadav, Alexander Hoff, Michael Steinbach, Vipin Kumar, Connie W Delaney, Gyorgy Simon
OBJECTIVES: To specify when delays of specific 3-hour bundle Surviving Sepsis Campaign guideline recommendations applied to severe sepsis or septic shock become harmful and impact mortality. DESIGN: Retrospective cohort study. SETTING: One health system composed of six hospitals and 45 clinics in a Midwest state from January 01, 2011, to July 31, 2015. PATIENTS: All adult patients hospitalized with billing diagnosis of severe sepsis or septic shock...
January 2, 2018: Critical Care Medicine
Birgitt Gutbier, Stefanie M Schönrock, Carolin Ehrler, Rainer Haberberger, Kristina Dietert, Achim D Gruber, Wolfgang Kummer, Laura Michalick, Wolfgang M Kuebler, Andreas C Hocke, Kolja Szymanski, Eleftheria Letsiou, Anja Lüth, Fabian Schumacher, Burkhard Kleuser, Timothy J Mitchell, Wilhelm Bertrams, Bernd Schmeck, Denise Treue, Frederick Klauschen, Torsten T Bauer, Mario Tönnies, Norbert Weissmann, Stefan Hippenstiel, Norbert Suttorp, Martin Witzenrath
OBJECTIVES: Severe pneumonia may evoke acute lung injury, and sphingosine-1-phosphate is involved in the regulation of vascular permeability and immune responses. However, the role of sphingosine-1-phosphate and the sphingosine-1-phosphate producing sphingosine kinase 1 in pneumonia remains elusive. We examined the role of the sphingosine-1-phosphate system in regulating pulmonary vascular barrier function in bacterial pneumonia. DESIGN: Controlled, in vitro, ex vivo, and in vivo laboratory study...
January 2, 2018: Critical Care Medicine
Rahul Raj, Stepani Bendel, Matti Reinikainen, Sanna Hoppu, Teemu Luoto, Tero Ala-Kokko, Sami Tetri, Ruut Laitio, Timo Koivisto, Jaakko Rinne, Riku Kivisaari, Jari Siironen, Alisa Higgins, Markus B Skrifvars
OBJECTIVE: To assess temporal trends in 1-year healthcare costs and outcome of intensive care for traumatic brain injury in Finland. DESIGN: Retrospective observational cohort study. SETTING: Multicenter study including four tertiary ICUs. PATIENTS: Three thousand fifty-one adult patients (≥ 18 yr) with significant traumatic brain injury treated in a tertiary ICU during 2003-2013. INTERVENTION: None...
January 2, 2018: Critical Care Medicine
Tim Howells, Peter Smielewski, Joseph Donnelly, Marek Czosnyka, Peter J A Hutchinson, David K Menon, Per Enblad, Marcel J H Aries
OBJECTIVES: The three centers in this study have different policies regarding cerebral perfusion pressure targets and use of vasopressors in traumatic brain injury patients. The aim was to determine if the different policies affected the estimation of cerebral perfusion pressure which optimizes the strength of cerebral autoregulation, termed "optimal cerebral perfusion pressure." DESIGN: Retrospective analysis of prospectively collected data. SETTING: Three neurocritical care units at university hospitals in Cambridge, United Kingdom, Groningen, the Netherlands, and Uppsala, Sweden...
January 2, 2018: Critical Care Medicine
Audrey De Jong, Daniel Verzilli, Mustapha Sebbane, Marion Monnin, Fouad Belafia, Moussa Cisse, Matthieu Conseil, Julie Carr, Boris Jung, Gérald Chanques, Nicolas Molinari, Samir Jaber
OBJECTIVES: To determine the short- and long-term mortality of obese ICU patients following medical as opposed to surgical admission and the relation between obesity and mortality. DESIGN: Retrospective analysis of prospectively collected data, using a propensity score-matched analysis of patients with medical or surgical admission. SETTING: One French mixed medical-surgical ICU. PATIENTS: Critically ill obese patients (body mass index ≥ 30 kg/m) and nonobese patients admitted during a 14-year period...
January 2, 2018: Critical Care Medicine
Daryl Jones, Alice Bhasale, Michael Bailey, David Pilcher, Matthew H Anstey
OBJECTIVES: To assess whether a national standard for improving care of deteriorating patients affected ICU admissions following cardiac arrests from hospital wards. DESIGN: Retrospective study assessing changes from baseline (January 1, 2008, to June 30, 2010), rollout (July 1, 2010, to December 31, 2012), and after (January 1, 2013, to 31 December 31, 2014) national standard introduction. Conventional inferential statistics, interrupted time series analysis, and adjusted hierarchical multiple logistic regression analysis...
January 2, 2018: Critical Care Medicine
Alison T Lai, Michelle P Zeller, Tina Millen, Peter Kavsak, Wojciech Szczeklik, Allahna Elahie, Waleed Alhazzani, Frederick D'Aragon, Roman Jaeschke, Francois Lamontagne, Timothy Karachi, Deborah Cook, Maureen Meade, Bram Rochwerg
OBJECTIVE: Use of hyperchloremic IV fluids for resuscitation in sepsis may be associated with increased mortality and use of renal replacement therapy. After crystalloids, 5% human albumin represents the second most common resuscitation fluid in the ICU. Its chloride concentration is rarely considered in the clinical setting. This study quantifies previously undocumented chloride concentrations of three 5% albumin solutions using biochemical analysis. DESIGN: We performed blinded analysis of the electrolyte concentration of albumin samples obtained directly from the national blood supplier (Canadian Blood Services)...
January 2, 2018: Critical Care Medicine
Nadir Yehya, Neal J Thomas, Robinder G Khemani
OBJECTIVE: Oxygenation measured 24 hours after acute respiratory distress syndrome onset more accurately stratifies risk, relative to oxygenation at onset, in both children and adults. However, waiting 24 hours is problematic, especially for interventions that are more efficacious early in the disease course. We aimed to delineate whether oxygenation measured at timepoints earlier than 24 hours would retain predictive validity in pediatric acute respiratory distress syndrome. DESIGN: Observational cohort study...
January 2, 2018: Critical Care Medicine
David M Griffith, Lisa G Salisbury, Robert J Lee, Nazir Lone, Judith L Merriweather, Timothy S Walsh
OBJECTIVES: ICU survivors frequently report reduced health-related quality of life, but the relative importance of preillness versus acute illness factors in survivor populations is not well understood. We aimed to explore health-related quality of life trajectories over 12 months following ICU discharge, patterns of improvement, or deterioration over this period, and the relative importance of demographics (age, gender, social deprivation), preexisting health (Functional Comorbidity Index), and acute illness severity (Acute Physiology and Chronic Health Evaluation II score, ventilation days) as determinants of health-related quality of life and relevant patient-reported symptoms during the year following ICU discharge...
January 2, 2018: Critical Care Medicine
Nishkantha Arulkumaran, Sean Pollen, Elisabetta Greco, Holly Courtneidge, Andrew M Hall, Michael R Duchen, Frederick W K Tam, Robert J Unwin, Mervyn Singer
OBJECTIVE: To explain the paradigm of significant renal functional impairment despite preserved hemodynamics and histology in sepsis-induced acute kidney injury. DESIGN: Prospective observational animal study. SETTING: University research laboratory. SUBJECTS: Male Wistar rats. INTERVENTION: Using a fluid-resuscitated sublethal rat model of fecal peritonitis, changes in renal function were characterized in relation to global and renal hemodynamics, and histology at 6 and 24 hours (n = 6-10)...
January 2, 2018: Critical Care Medicine
Claire Shappell, Ashley Snyder, Dana P Edelson, Matthew M Churpek
OBJECTIVES: Despite wide adoption of rapid response teams across the United States, predictors of in-hospital mortality for patients receiving rapid response team calls are poorly characterized. Identification of patients at high risk of death during hospitalization could improve triage to intensive care units and prompt timely reevaluations of goals of care. We sought to identify predictors of in-hospital mortality in patients who are subjects of rapid response team calls and to develop and validate a predictive model for death after rapid response team call...
January 2, 2018: Critical Care Medicine
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