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Journal of Critical Care

João Gabriel Rosa Ramos, Rogério da Hora Passos, Mauricio Brito Teixeira, Andre Luiz Nunes Gobatto, Rafael Viana Dos Santos Coutinho, Juliana Ribeiro Caldas, Suzete Farias da Guarda, Michel Pordeus Ribeiro, Paulo Benigno Pena Batista
OBJECTIVES: Sepsis identification in older patients is challenging. We evaluated the performance of qSOFA across different age groups of patients with suspected infection outside the intensive care unit (ICU). METHODS: Retrospective cohort in a tertiary hospital in Brazil, from January 2016 to December 2016. Outcomes were hospital mortality, ICU admission and bacteremia. Performance of qSOFA was compared over three age groups: (1) reference: ≤65 years, (2) old: 65 to 79 years and (3) very old: ≥80 years...
July 7, 2018: Journal of Critical Care
Kyle C Mangan, Brian P McKinzie, Lindsay P Deloney, Stuart M Leon, Evert A Eriksson
PURPOSE: Dosing regimens of quetiapine to treat delirium in critically ill patients are titrated to effect, and may utilize doses higher than previously reported. This study aimed to assess the safety of quetiapine for this indication. MATERIALS AND METHODS: A retrospective medical chart review was conducted, identifying 154 critically ill adults that were initiated on quetiapine to treat delirium and monitored for QTc prolongation. RESULTS: The median average daily dose was 150 mg (79-234) and median max dose was 225 mg (100-350)...
July 5, 2018: Journal of Critical Care
Sofie A M Dhaese, Magalie De Kezel, Maxime Callant, Jerina Boelens, Liesbet De Bus, Pieter Depuydt, Jan J De Waele
BACKGROUND: Prolonged infusion of beta-lactam antibiotics is broadly recognized as a strategy to optimize antibiotic therapy by achieving a higher percentage of time that concentrations remain above the minimal inhibitory concentration (% fT>MIC ), i.e. the pharmacokinetic/pharmacodynamic (PK/PD) index. However, %fT>MIC may not be the PK/PD index of choice for inhibition of resistance emergence and it is therefore unsure what impact prolonged infusion of beta-lactam antibiotics may have on the emergence of resistance...
July 4, 2018: Journal of Critical Care
Vikesh Patel, Maryanne Z A Mariyaselvam, Catherine Peutherer, Peter J Young
PURPOSE: The inadvertent, simultaneous use of heat and moisture exchangers (HMEs) and heated humidifiers (HHs) can result in waterlogging of the filter and sudden ventilation tube occlusion, with potentially fatal consequences. Following an NHS England Safety Alert, a near miss and educational reminders in our institution, we introduced new guidelines to solely use HHs in the intensive care unit and HMEs only for patient transfers. No further incidents have occurred, however this solution is potentially fallible...
June 30, 2018: Journal of Critical Care
Yasutaka Koga, Motoki Fujita, Takeshi Yagi, Masaki Todani, Takashi Nakahara, Yoshikatsu Kawamura, Kotaro Kaneda, Yasutaka Oda, Ryosuke Tsuruta
PURPOSE: To determine whether the association of early enteral nutrition (EEN) with mortality from sepsis differs between patients with and without sarcopenia. MATERIALS AND METHODS: We retrospectively reviewed septic patients treated at our centre between January 2010 and August 2017. The skeletal muscle area (SMA) at the level of the third lumbar vertebra was measured with CT on admission, and sarcopenia was defined as SMA < 80% of the predicted value. Patients were divided into two subgroups (sarcopenic and non-sarcopenic patients), and in-hospital mortality was compared in patients treated with and without EEN within each subgroup...
June 30, 2018: Journal of Critical Care
Oleksa G Rewa, Dean T Eurich, R T Noel Gibney, Sean M Bagshaw
BACKGROUND: Continuous renal replacement therapy (CRRT) is a complex and life-sustaining therapy, reserved for our most acutely ill patients, and should be delivered in a safe, consistent and high-quality manner. However valid evidence-based quality indicators (QIs) for CRRT care are lacking. The objective of this study was to develop a prioritized list of QIs for CRRT care that may be used in any CRRT program. METHOD: We conducted a modified three stage Delphi process...
June 30, 2018: Journal of Critical Care
Leonardo Lorente, María M Martín, Antonia Pérez-Cejas, Pedro Abreu-González, Raquel Ortiz López, José Ferreres, Jordi Solé-Violán, Lorenzo Labarta, César Díaz, Salomé Palmero, Alejandro Jiménez
PURPOSE: Higher circulating total antioxidant capacity (TAC) concentrations have been found in non-survivor than in survivor septic patients at moment of sepsis diagnosis. The objectives of this study were to determine whether serum TAC levels during the first week of sepsis are associated with lipid peroxidation, sepsis severity, and sepsis mortality, and whether could be used as a prognostic biomarker. METHODS: This prospective and observational study with 319 septic patients admitted to Intensive Care Units was carried out in 8 Spanish hospitals...
June 30, 2018: Journal of Critical Care
Shunsuke Taito, Nobuaki Shime, Hideto Yasuda, Kohei Ota, Kazuhiro Sarada, Alan Kawarai Lefor, Masamitsu Sanui
PURPOSE: The aim of this study is to clarify intensive care unit (ICU)-level factors facilitating out-of-bed mobilization defined as a range of activities from sitting on edge of bed up to walking in mechanically ventilated patients with orotracheal tubes. MATERIALS AND METHODS: We conducted a survey of all intensive care units (ICUs) certified by the Japanese Society of Intensive Care Medicine (excluding pediatric ICUs) as training facilities for intensivists. RESULTS: We surveyed 294 ICUs, with a response rate of 57% (n = 168)...
June 28, 2018: Journal of Critical Care
David J Murray, Walter A Boyle, Mary Beth Beyatte, Justin G Knittel, Paul W Kerby, Julie Woodhouse, John R Boulet
PURPOSE: Health care professionals are expected to acquire decision-making skills during their training, but few methods are available to assess progress in acquiring these essential skills. The purpose of this study was to determine whether a simulation methodology could be used to assess whether decision-making skills improve during critical care training. MATERIALS AND METHODS: Sixteen simulated scenarios were designed to assess a critical care provider's ability to make decisions in the care of a critical ill patient...
June 25, 2018: Journal of Critical Care
Oded Cohen, Ruth Shnipper, Liron Yosef, Dekel Stavi, Yael Shapira-Galitz, Moshe Hain, Yonatan Lahav, Hagit Shoffel-Havakuk, Doron Halperin, Nimrod Adi
PURPOSE: To assess the safety of medical-ward bedside percutaneous dilatational tracheostomy (GWB-PDT). MATERIALS AND METHODS: A retrospective study of all patients who underwent elective GWB-PDT between 2009 and 2015. A joint otolaryngology-ICU team performed all GWB-PDTs. The patients were followed until decannulation, discharge or death. Complications were divided into early (within 24 h) and late, and into minor and major. RESULTS: Two hundred and fifty six patients were included in the study...
June 21, 2018: Journal of Critical Care
Alexandre Gaudet, Erika Parmentier, Sylvain Dubucquoi, Julien Poissy, Thibault Duburcq, Philippe Lassalle, Nathalie De Freitas Caires, Daniel Mathieu
PURPOSE: Endocan is a circulating proteoglycan measured at high blood levels during severe sepsis, with a likely lung anti-inflammatory function. The aim of this study was to assess whether paradoxically low endocan levels at Intensive Care Unit (ICU) admission could predict Acute Respiratory Distress Syndrome (ARDS) within 72 h in severe septic patients. MATERIALS AND METHODS: Patients admitted for severe sepsis in the ICU of a French University Hospital were included in a prospective single-center observational study between October 2014 and March 2016...
June 20, 2018: Journal of Critical Care
Jacob C Jentzer, Nandan S Anavekar, Sunil V Mankad, Majd Khasawneh, Roger D White, Gregory W Barsness, Alejandro A Rabinstein, Kianoush B Kashani, Sorin V Pislaru
PURPOSE: To determine whether systolic or diastolic dysfunction on transthoracic echocardiogram (TTE) predicts mortality after out-of-hospital cardiac arrest (OHCA). METHODS: Retrospective cohort study of 173 OHCA subjects undergoing targeted temperature management who underwent TTE during hospitalization. Univariate analysis and multivariate logistic regression were used to determine associations between TTE measurements of systolic and diastolic function and systemic hemodynamics with all-cause mortality...
June 19, 2018: Journal of Critical Care
Won Kyoung Jhang, EunJu Ha, Seong Jong Park
PURPOSE: To evaluated the outcome predictability of DIC scores in critically ill children with septic shock. MATERIALS AND METHODS: Pediatric patients with septic shock who were admitted to the pediatric intensive care unit of a tertiary care children's hospital between January 2013 and December 2017 were enrolled. We analyzed the association between DIC and clinical outcomes. DIC was diagnosed based on the International Society on Thrombosis and Hemostasis (ISTH), Japanese Association for Acute Medicine (JAAM), and modified JAAM DIC criteria...
June 19, 2018: Journal of Critical Care
Lisa Smart, Erika Bosio, Stephen P J Macdonald, Randal Dull, Daniel M Fatovich, Claire Neil, Glenn Arendts
PURPOSE: Endocan, a component of the endothelial glycocalyx (EG), has been linked with respiratory failure in sepsis. This study explored the temporal patterns of three EG biomarkers, including endocan, and their relationships with inflammation and respiratory failure. MATERIALS AND METHODS: Plasma endocan, syndecan-1, and hyaluronan concentrations were measured in Emergency Department (ED) patients with sepsis due to pneumonia (n = 44) on ED arrival (T0), 1 h (T1), 3 h (T3) and 12-24 h (T24) later, with change over time tested using mixed regression models...
June 18, 2018: Journal of Critical Care
Ashish K Khanna, Frank J Overdyk, Christine Greening, Paola Di Stefano, Wolfgang F Buhre
Predicting episodes or severity of cardiorespiratory decompensation has proved to be challenging in patients with stable surgical or medical conditions, recovering on the general care floor (ward). Critical cardiorespiratory events on hospital floors may be prevented by early detection of deterioration using continuous, electronic cardiorespiratory monitoring (CEM). The PRediction of Opioid-induced Respiratory Depression In Patients Monitored by capnoGraphY (PRODIGY) trial investigates CEM using pulse oximetry and capnography in 1650 patients at 16 centers in North America, Europe, and Asia (ClinicalTrials...
June 18, 2018: Journal of Critical Care
Louise Rose, Laura Istanboulian, Orla M Smith, Soledad Silencieux, Brian H Cuthbertson, Andre Carlos Kajdacsy-Balla Amaral, Ian Fraser, Joanne Grey, Craig Dale
PURPOSE: To assess feasibility of producing intelligible and comprehensible speech with an electrolarynx; measure anxiety, communication ease, and satisfaction before/after electrolarynx training; and identify barriers/facilitators. METHODS: We included tracheostomized adults from 3 units following commands, reading English, and mouthing words. On enrolment, we measured anxiety, ease, and satisfaction with communication. We gave electrolarynx instruction for ≤5 days then 2 independent raters assessed intelligibility, sentence comprehensibility (9-point difficulty scale), and Electrolarynx Effectiveness Score (EES), and re-evaluated anxiety, communication ease, and satisfaction...
June 12, 2018: Journal of Critical Care
Frederico Castro Costa Póvoa, Pablo Cardinal-Fernandez, Israel Silva Maia, Maycon Moura Reboredo, Bruno Valle Pinheiro
No abstract text is available yet for this article.
June 12, 2018: Journal of Critical Care
Pradeep Bhatia, Ankur Sharma, Sunit Gupta, Varuna Vyas, Narender Kaloria, Priyanka Sethi
No abstract text is available yet for this article.
June 9, 2018: Journal of Critical Care
Guillaume Hékimian, Tamara Jovanovic, Nicolas Bréchot, Guillaume Lebreton, Pascal Leprince, Jean-Louis Trouillet, Matthieu Schmidt, Ania Nieszkowska, Sébastien Besset, Jean Chastre, Alain Combes, Charles-Edouard Luyt
PURPOSE: To describe patients with refractory cardiogenic shock related to influenza B virus myocarditis rescued by venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO). MATERIAL AND METHODS: Consecutive patients hospitalized in our unit for influenza-associated myocarditis were prospectively included. We also conducted a systematic MEDLINE database literature review through the PubMed search engine, between 1946 and 2017. RESULTS: We report the cases of 4 young patients with fulminant myocarditis requiring VA-ECMO for 6 [5-8] days...
June 9, 2018: Journal of Critical Care
Dianne E C van Beek, Marc H H Königs, Yvette A M Kuijpers, Iwan C C van der Horst, Thomas W L Scheeren
No abstract text is available yet for this article.
June 8, 2018: Journal of Critical Care
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