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Critical Care Medicine

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https://www.readbyqxmd.com/read/28906287/racial-disparities-in-sepsis-related-in-hospital-mortality-using-a-broad-case-capture-method-and-multivariate-controls-for-clinical-and-hospital-variables-2004-2013
#1
Jenna M Jones, Kathryn R Fingar, Melissa A Miller, Rosanna Coffey, Marguerite Barrett, Thomas Flottemesch, Kevin C Heslin, Darryl T Gray, Ernest Moy
OBJECTIVES: As sepsis hospitalizations have increased, in-hospital sepsis deaths have declined. However, reported rates may remain higher among racial/ethnic minorities. Most previous studies have adjusted primarily for age and sex. The effect of other patient and hospital characteristics on disparities in sepsis mortality is not yet well-known. Furthermore, coding practices in claims data may influence findings. The objective of this study was to use a broad method of capturing sepsis cases to estimate 2004-2013 trends in risk-adjusted in-hospital sepsis mortality rates by race/ethnicity to inform efforts to reduce disparities in sepsis deaths...
September 12, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28906286/serial-daily-organ-failure-assessment-beyond-icu-day-5-does-not-independently-add-precision-to-icu-risk-of-death-prediction
#2
Andre L Holder, Elizabeth Overton, Peter Lyu, Jordan A Kempker, Shamim Nemati, Fereshteh Razmi, Greg S Martin, Timothy G Buchman, David J Murphy
OBJECTIVES: To identify circumstances in which repeated measures of organ failure would improve mortality prediction in ICU patients. DESIGN: Retrospective cohort study, with external validation in a deidentified ICU database. SETTING: Eleven ICUs in three university hospitals within an academic healthcare system in 2014. PATIENTS: Adults (18 yr old or older) who satisfied the following criteria: 1) two of four systemic inflammatory response syndrome criteria plus an ordered blood culture, all within 24 hours of hospital admission; and 2) ICU admission for at least 2 calendar days, within 72 hours of emergency department presentation...
September 12, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28906285/impact-of-missing-physiologic-data-on-performance-of-the-simplified-acute-physiology-score-3-risk-prediction-model
#3
Lars Engerström, Thomas Nolin, Caroline Mårdh, Folke Sjöberg, Göran Karlström, Mats Fredrikson, Sten M Walther
OBJECTIVES: The Simplified Acute Physiology 3 outcome prediction model has a narrow time window for recording physiologic measurements. Our objective was to examine the prevalence and impact of missing physiologic data on the Simplified Acute Physiology 3 model's performance. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Sixty-three ICUs in the Swedish Intensive Care Registry. PATIENTS: Patients admitted during 2011-2014 (n = 107,310)...
September 12, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28906284/effect-of-transfusion-on-mortality-and-other-adverse-events-among-critically-ill-septic-patients-an-observational-study-using-a-marginal-structural-cox-model
#4
Claire Dupuis, Maité Garrouste-Orgeas, Sébastien Bailly, Christophe Adrie, Dany Goldgran-Toledano, Elie Azoulay, Stéphane Ruckly, Guillaume Marcotte, Bertrand Souweine, Michael Darmon, Yves Cohen, Carole Schwebel, Guillaume Lacave, Lila Bouadma, Jean-Francois Timsit
OBJECTIVES: RBC transfusion is often required in patients with sepsis. However, adverse events have been associated with RBC transfusion, raising safety concerns. A randomized controlled trial validated the 7 g/dL threshold, but previously transfused patients were excluded. Cohort studies led to conflicting results and did not handle time-dependent covariates and history of treatment. Additional data are thus warranted to guide patient's management. DESIGN: To estimate the effect of one or more RBC within 1 day on three major outcomes (mortality, ICU-acquired infections, and severe hypoxemia) at day 30, we used marginal structural models...
September 12, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28902121/critical-care-resources-in-guangdong-province-of-china-three-surveys-from-2005-to-2015
#5
Jian-Feng Wu, Fei Pei, Bin Ouyang, Juan Chen, Yi-Min Li, Yong-Wen Feng, Fa-Liang Guo, Li-Xin Zhou, Zheng Wang, Ying-Jun Guo, Qin-Han Lin, Zhan-Peng Li, Yun Ling, Li Li, Lie-Hua Deng, Ying-Ping Zhao, Jian-Wei Dai, Shu-Yu Luo, Dun-Rong Zhou, Wei-Wen Luo, Ling Zhao, Wei-Ying Chen, Wei-Chuan Wang, Wen-Yang Cai, Qiong-Xiang Luo, Xiang-Dong Guan
OBJECTIVES: Data about the critical care resources in China remain scarce. The purpose of this study was to investigate the variation and distribution of critical care resources in Guangdong province from 2005 to 2015. DESIGN: Data in regard to critical care resources were collected through questionnaires and visits every 5 years from 2005. SETTING: All hospitals in Guangdong province were screened and hospitals that provide critical care services were enrolled...
September 8, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28872540/effects-on-pulmonary-vascular-mechanics-of-two-different-lung-protective-ventilation-strategies-in-an-experimental-model-of-acute-respiratory-distress-syndrome
#6
Arnoldo Santos, Eva Gomez-Peñalver, M Ignacio Monge-Garcia, Jaime Retamal, João Batista Borges, Gerardo Tusman, Goran Hedenstierna, Anders Larsson, Fernando Suarez-Sipmann
OBJECTIVES: To compare the effects of two lung-protective ventilation strategies on pulmonary vascular mechanics in early acute respiratory distress syndrome. DESIGN: Experimental study. SETTING: University animal research laboratory. SUBJECTS: Twelve pigs (30.8 ± 2.5 kg). INTERVENTIONS: Acute respiratory distress syndrome was induced by repeated lung lavages and injurious mechanical ventilation...
September 1, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28863013/cell-free-plasma-hemoglobin-and-male-gender-are-risk-factors-for-acute-kidney-injury-in-low-risk-children-undergoing-cardiopulmonary-bypass
#7
Nahmah Kim-Campbell, Catherine Gretchen, Clifton Callaway, Kathryn Felmet, Patrick M Kochanek, Timothy Maul, Peter Wearden, Mahesh Sharma, Melita Viegas, Ricardo Munoz, Mark T Gladwin, Hülya Bayir
OBJECTIVES: To determine the relationship between the production of cell-free plasma hemoglobin and acute kidney injury in infants and children undergoing cardiopulmonary bypass for cardiac surgery. DESIGN: Prospective observational study. SETTING: Twelve-bed cardiac ICU in a university-affiliated children's hospital. PATIENTS: Children were prospectively enrolled during their preoperative outpatient appointment with the following criteria: greater than 1 month to less than 18 years old, procedures requiring cardiopulmonary bypass, no preexisting renal dysfunction...
August 31, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28863012/critical-care-organizations-business-of-critical-care-and-value-performance-building
#8
Sharon Leung, Sara R Gregg, Craig M Coopersmith, A Joseph Layon, John Oropello, Daniel R Brown, Stephen M Pastores, Vladimir Kvetan
OBJECTIVE: New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1)...
August 31, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28863011/sedation-and-mobilization-during-venovenous-extracorporeal-membrane-oxygenation-for-acute-respiratory-failure-an-international-survey
#9
Jonathan D Marhong, Julian DeBacker, Julien Viau-Lapointe, Laveena Munshi, Lorenzo Del Sorbo, Lisa Burry, Eddy Fan, Sangeeta Mehta
OBJECTIVES: To characterize sedation, analgesia, delirium, and mobilization practices in patients supported with venovenous extracorporeal membrane oxygenation for severe acute respiratory failure. DESIGN: Cross-sectional electronic survey administered January 2016 to March 2016. SETTING: Three-hundred ninety-four extracorporeal membrane oxygenation centers registered with the Extracorporeal Life Support Organization. SUBJECTS: Extracorporeal membrane oxygenation medical directors and program coordinators...
August 31, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28857907/predicting-fluid-responsiveness-in-critically-ill-patients-by-using-combined-end-expiratory-and-end-inspiratory-occlusions-with-echocardiography
#10
Mathieu Jozwiak, François Depret, Jean-Louis Teboul, Jean-Emmanuel Alphonsine, Christopher Lai, Christian Richard, Xavier Monnet
OBJECTIVES: First, we aimed at assessing whether fluid responsiveness is predicted by the effects of an end-expiratory occlusion on the velocity-time integral of the left ventricular outflow tract. Second, we investigated whether adding the effects of an end-inspiratory occlusion and of an end-expiratory occlusion on velocity-time integral can predict fluid responsiveness with similar reliability than end-expiratory occlusion alone but with a higher threshold, which might be more compatible with the precision of echocardiography...
August 29, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28857855/-it-was-the-only-thing-i-could-hold-onto-but%C3%A2-receiving-a-letter-of-condolence-after-loss-of-a-loved-one-in-the-icu-a-qualitative-study-of-bereaved-relatives-experience
#11
Nancy Kentish-Barnes, Zoé Cohen-Solal, Virginie Souppart, Marion Galon, Benoît Champigneulle, Marina Thirion, Marion Gilbert, Olivier Lesieur, Anne Renault, Maïté Garrouste-Orgeas, Laurent Argaud, Marion Venot, Alexandre Demoule, Olivier Guisset, Isabelle Vinatier, Gilles Troché, Julien Massot, Samir Jaber, Caroline Bornstain, Véronique Gaday, René Robert, Jean-Philippe Rigaud, Raphaël Cinotti, Mélanie Adda, François Thomas, Elie Azoulay
OBJECTIVES: Family members of patients who die in the ICU often remain with unanswered questions and suffer from lack of closure. A letter of condolence may help bereaved relatives, but little is known about their experience of receiving such a letter. The objective of the study was to understand bereaved family members' experience of receiving a letter of condolence. DESIGN: Qualitative study using interviews with bereaved family members who received a letter of condolence and letters written by these family members to the ICU team...
August 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28857854/heparin-free-prolonged-intermittent-hemodialysis-using-calcium-free-citrate-dialysate-in-critically-ill-patients
#12
Stanislas Faguer, Morgane Saint-Cricq, Marie-Béatrice Nogier, Isabelle Labadens, Laurence Lavayssiere, Nassim Kamar, Olivier Cointault
OBJECTIVES: Critically ill patients who have a high risk of bleeding but require prolonged intermittent dialysis need a heparin-free easy-to-use alternative type of anticoagulation within the dialysis circuit. We assessed the safety and efficiency of heparin-free regional citrate anticoagulation of the dialysis circuit using a calcium-free citrate-containing dialysate, with calcium reinjected according to ionic dialysance. DESIGN: Prospective cohort study. SETTING: Critical care units...
August 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28857853/valproic-acid-combined-with-postcardiac-arrest-hypothermic-targeted-temperature-management-prevents-delayed-seizures-and-improves-survival-in-a-rat-cardiac-arrest-model
#13
Joo Suk Oh, Jinka Tulasi, Ren Xiaodan, William C Stacey, Robert W Neumar
OBJECTIVES: High-dose valproic acid in combination with hypothermic-targeted temperature management has been reported to synergistically improve neurologic outcomes after cardiac arrest. This study investigated the potential synergistic mechanisms. DESIGN: Prospective, randomized, experimental study. SETTING: University research institution. SUBJECTS: Male Long Evans rats. INTERVENTION: Rats resuscitated from asphyxial cardiac arrest were randomized to one of the three groups: normothermic-targeted temperature management (37°C ± 1°C), hypothermic-targeted temperature management (33° ± 1° × 24 hr + placebo infusion), hypothermic-targeted temperature management plus high-dose valproic acid (300 mg/kg IV × 1 initiated 5 min post return of spontaneous circulation and infused over 20 min) (hypothermic-targeted temperature management + valproic acid)...
August 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28857852/effects-of-high-flow-nasal-cannula-on-the-work-of-breathing-in-patients-recovering-from-acute-respiratory-failure
#14
Mathieu Delorme, Pierre-Alexandre Bouchard, Mathieu Simon, Serge Simard, François Lellouche
OBJECTIVES: High-flow nasal cannula is increasingly used in the management of respiratory failure. However, little is known about its impact on respiratory effort, which could explain part of the benefits in terms of comfort and efficiency. This study was designed to assess the effects of high-flow nasal cannula on indexes of respiratory effort (i.e., esophageal pressure variations, esophageal pressure-time product/min, and work of breathing/min) in adults. DESIGN: A randomized controlled crossover study was conducted in 12 patients with moderate respiratory distress (i...
August 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28857851/antifungal-prevention-of-systemic-candidiasis-in-immunocompetent-icu-adults-systematic-review-and-meta-analysis-of-clinical-trials
#15
Hervé Dupont, Yazine Mahjoub, Taieb Chouaki, Emmanuel Lorne, Elie Zogheib
OBJECTIVES: The aim of this study was to identify the impact of antifungal prevention in critically ill immunocompetent adult patients on mortality and subsequent infection. DATA SOURCES: A systematic review and meta-analysis of randomized controlled trials comparing any antifungal use versus placebo to prevent candidiasis in ICU patients were performed. STUDY SELECTION: Searches were performed on PubMed, Embase, Scopus, main conference proceedings, and ClinicalTrials...
August 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28857850/interventions-to-improve-hand-hygiene-compliance-in-the-icu-a-systematic-review
#16
Sinéad Lydon, Michael Power, Jennifer McSharry, Molly Byrne, Caoimhe Madden, Janet Elaine Squires, Paul O'Connor
OBJECTIVES: To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described. DATA SOURCES: Systematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened. STUDY SELECTION: English language, peer-reviewed studies that evaluated an intervention to improve hand hygiene in an adult ICU setting, and reported hand hygiene compliance rates collected via observation, were included...
August 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28857849/advanced-percutaneous-mechanical-circulatory-support-devices-for-cardiogenic-shock
#17
P Elliott Miller, Michael A Solomon, Dorothea McAreavey
OBJECTIVES: To review temporary percutaneous mechanical circulatory support devices for the treatment of cardiogenic shock, including current evidence, contraindications, complications, and future directions. DATA SOURCES: A MEDLINE search was conducted with MeSH terms: cardiogenic shock, percutaneous mechanical circulatory support, extracorporeal membrane oxygenation, Impella, and TandemHeart. STUDY SELECTION: Selected publications included randomized controlled trial data and observational studies describing experience with percutaneous mechanical circulatory support in cardiogenic shock...
August 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28857848/nebulized-versus-iv-amikacin-as-adjunctive-antibiotic-for-hospital-and-ventilator-acquired-pneumonia-postcardiac-surgeries-a-randomized-controlled-trial
#18
Nehal A Hassan, Faten Farid Awdallah, Maggie M Abbassi, Nirmeen A Sabry
OBJECTIVE: Nebulized antibiotics offer high efficacy due to significant local concentrations and safety with minimal blood levels. This study evaluates the efficacy and nephrotoxicity of nebulized versus IV amikacin in postcardiothoracic surgical patients with nosocomial pneumonia caused by multidrug-resistant Gram--negative bacilli. DESIGN: Prospective, randomized, controlled study on surgical patients divided into two groups. SETTING: Postcardiac surgery ICU...
August 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28841633/extracorporeal-circulatory-support-in-acute-coronary-syndromes-a-systematic-review-and-meta-analysis
#19
Rita Pavasini, Chiara Cirillo, Gianluca Campo, Miguel Nobre Menezes, Simone Biscaglia, Elisabetta Tonet, Roberto Ferrari, Brijesh V Patel, Susanna Price
OBJECTIVES: Extracorporeal circulatory support is a life-saving technique, and its use is increasing in acute coronary syndromes. A meta-analysis on pooled event rate of short-term mortality and complications of acute coronary syndrome patients treated with extracorporeal circulatory support was performed. DATA SOURCES: Articles were searched in MEDLINE, Cochrane Library, Google Scholar, and Biomed Central. STUDY SELECTION: Inclusion criteria were observational studies on acute coronary syndrome patients treated with extracorporeal circulatory support...
August 24, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28841632/delirium-and-catatonia-in-critically-ill-patients-the-delirium-and-catatonia-prospective-cohort-investigation
#20
Jo E Wilson, Richard Carlson, Maria C Duggan, Pratik Pandharipande, Timothy D Girard, Li Wang, Jennifer L Thompson, Rameela Chandrasekhar, Andrew Francis, Stephen E Nicolson, Robert S Dittus, Stephan Heckers, E Wesley Ely
OBJECTIVES: Catatonia, a condition characterized by motor, behavioral, and emotional changes, can occur during critical illness and appear as clinically similar to delirium, yet its management differs from delirium. Traditional criteria for medical catatonia preclude its diagnosis in delirium. Our objective in this investigation was to understand the overlap and relationship between delirium and catatonia in ICU patients and determine diagnostic thresholds for catatonia. DESIGN: Convenience cohort, nested within two ongoing randomized trials...
August 24, 2017: Critical Care Medicine
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