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Journal of Critical Care

Fernando da Silveira, Wagner Luis Nedel, Renato Cassol, Patricia Reis Pereira, Caroline Deutschendorf, Thiago Lisboa
INTRODUCTION: Acinetobacter species treatment often represents a challenge. The main objective of this study is identify predictors of ICU mortality in patients submitted to mechanical ventilation (MV). MATERIALS AND METHODS: Retrospective cohort study. Patients with MV > 48 h who developed a respiratory tract positive culture for Acinetobacter were included, and distinguished among colonized, ventilator-associated pneumonia (VAP) or ventilator-associated tracheobronchitis (VAT) patients...
November 3, 2018: Journal of Critical Care
Tina Maes, Annelies Meuwissen, Marc Diltoer, Duc Nam Nguyen, Mark La Meir, Robert Wise, Herbert Spapen, Manu L N G Malbrain, Elisabeth De Waele
INTRODUCTION: Standardized protocols are provided for maintenance and replacement fluid therapy in critically ill patients. However, unintended fluid sources (analgesics, antibiotics and other drugs) are not always taken into account when prescribing intravenous fluid therapy. We evaluated the extent to which maintenance, resuscitation and unintended fluids contributed to total fluid load in elective coronary artery bypass graft patients during their ICU stay. METHODS: Data on intravenous and oral fluid input and output were retrospectively collected from the electronic medical files...
November 1, 2018: Journal of Critical Care
David M Maslove, Tal Shapira, Kathrin Tyryshkin, Richard A Veldhoen, John C Marshall, John Muscedere
PURPOSE: Gene expression diagnostics have been proposed to identify critically ill patients with sepsis. Three expression-based scores have been developed, but have not been compared in a prospective validation. We sought to validate these scores using an independent dataset and analysis. METHODS: We generated gene expression profiles from 61 critically ill patients. We validated the performance of 3 expression-based sepsis scores including 1) the Sepsis MetaScore (SMS); 2) the SeptiCyte™ Lab; and 3) the FAIM3:PLAC8 ratio...
November 1, 2018: Journal of Critical Care
Swathikan Chidambaram, En Lin Goh, Vanessa Garnelo Rey, Mansoor Ali Khan
PURPOSE: The metabolic and circulatory disturbances in patients with septic shock results in a high mortality rate. There is a lack of high-level evidence on the optimal approach. We present a meta-analysis elucidating the outcomes of regimes with only noradrenaline versus a combination of noradrenaline and vasopressin in managing septic shock. METHODS: A literature search of studies comparing the use of noradrenaline and vasopressin in septic shock was conducted, using MEDLINE and EMBASE databases...
October 31, 2018: Journal of Critical Care
Marie-José Roos-Blom, Wouter T Gude, Jan Jaap Spijkstra, Evert de Jonge, Dave Dongelmans, Nicolette F de Keizer
PURPOSE: To evaluate the quality of pain assessment in Dutch ICUs and its room for improvement. MATERIALS AND METHODS: We used a modified RAND method to develop pain assessment indicators. We measured performance on the indicators using retrospectively collected pain measurement data from Dutch ICUs, which are all mixed medical - surgical, of three months within October 2016-May 2017. We assessed the room for improvement, feasibility of data collection, and reliability of the indicators...
October 30, 2018: Journal of Critical Care
Brian H Nathanson, Thomas L Higgins, Mihaela Stefan, Tara Lagu, Peter K Lindenauer, Jay S Steingrub
PURPOSE: To assess how homelessness impacts mortality and length of stay (LOS) among select the intensive care unit (ICU) patients. METHODS: We used ICD-9 code V60.0 to identify homeless patients using the Premier Perspective Database from January 2010 to June 2011. We identified three subpopulations who received critical care services using ICD-9 and Medicare Severity Diagnosis Related Groups (MS-DRG) codes: patients with a diagnosis of sepsis who were treated with antibiotics by Day 2, patients with an alcohol or drug related MS-DRG, and patients with a diabetes related MS-DRG...
October 30, 2018: Journal of Critical Care
Yasutaka Koga, Motoki Fujita, Takeshi Yagi, Masaki Todani, Takashi Nakahara, Yoshikatsu Kawamura, Kotaro Kaneda, Yasutaka Oda, Ryosuke Tsuruta
No abstract text is available yet for this article.
October 29, 2018: Journal of Critical Care
Sofia Dahlberg, Leon Schurgers, Ulf Schött, Thomas Kander
BACKGROUND: Vitamin K is a cofactor for proteins involved in cardiovascular health, bone metabolism and cancer. Measuring uncarboxylated prothrombin, also termed as "protein induced by vitamin K absence or antagonism for factor II (PIVKA-II)", has been used to assess vitamin K status. High levels may indicate vitamin K deficiency. The aim of this study was to measure PIVKA-II and prothrombin time (PT-INR) in intensive care (ICU) patients and correlate vitamin K status with mortality...
October 28, 2018: Journal of Critical Care
Heather Torbic, Abhijit Duggal
Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate thereby resulting in respiratory failure. Treatment of ARDS is often a multimodal approach using both nonpharmacologic and pharmacologic treatment strategies in addition to trying to reverse the underlying cause of ARDS. Neuromuscular blocking agents (NMBAs) have been prescribed to patients with ARDS as they are thought to decrease inflammation, oxygen consumption, and cardiac output and help facilitate ventilator synchrony...
October 28, 2018: Journal of Critical Care
Melis Ketenci, Umut Safer, Mustafa Kaplan, Vildan Binay Safer
No abstract text is available yet for this article.
October 28, 2018: Journal of Critical Care
Marleen M van Eijck, Marlou O P Sprengers, Annemarie W Oldenbeuving, Jolanda de Vries, Guus G Schoonman, Gerwin Roks
PURPOSE: 1) To determine the clinical expression and consequences of autonomic dysregulation in patients with diffuse axonal injury (DAI), and 2) to study the use of the "paroxysmal sympathetic hyperactivity assessment measure" (PSH-AM). METHODS: Patients clinically diagnosed with autonomic dysregulation were selected from a cohort involving 116 patients with DAI. We studied the incidence of autonomic features, treatment, and outcome. In addition a systematic review was performed...
October 27, 2018: Journal of Critical Care
Zachary O'Brien, Alan Cass, Louise Cole, Simon Finfer, Martin Gallagher, Colin McArthur, Shay McGuiness, John Myburgh, Rinaldo Bellomo, Johan Mårtensson
PURPOSE: To investigate the relationship between sex and mortality and whether menopause or the intensity of renal replacement therapy (RRT) modify this relationship in patients with severe septic acute kidney injury (AKI). MATERIALS AND METHODS: Post-hoc analysis of patients with sepsis included in the Randomized Evaluation of Normal versus Augmented Level renal replacement therapy (RENAL) trial. RESULTS: Of 724 patients, 458 (63.3%) were male and 266 (36...
October 23, 2018: Journal of Critical Care
Matthew P Linnane, Lawrence R Caruana, Oystein Tronstad, Amanda Corley, Amy J Spooner, Adrian G Barnett, Peter J Thomas, James R Walsh
PURPOSE: Endotracheal suctioning (ES) of mechanically ventilated patients decreases end-expiratory lung volume (EELV). Manual hyperinflation (MHI) and ventilator hyperinflation (VHI) may restore EELV post-ES but it remains unknown which method is most effective. The primary aim was to compare the efficacy of MHI and VHI in restoring EELV post-ES. MATERIALS AND METHODS: ES was performed on mechanically ventilated intensive care patients, followed by MHI or VHI, in a randomised crossover design...
October 22, 2018: Journal of Critical Care
Pieter Hoste, Patrick Ferdinande, Dirk Vogelaers, Kris Vanhaecht, Eric Hoste, Xavier Rogiers, Kristof Eeckloo, Koenraad Vandewoude
PURPOSE: Guideline adherence for the management of a donor after brain death (DBD) is largely unknown. This study aimed to perform an importance-performance analysis of prioritized key interventions (KIs) by linking guideline adherence rates to expert consensus ratings for the management of a DBD. MATERIALS AND METHODS: This observational, cross-sectional multicenter study was performed in 21 Belgian ICUs. A retrospective review of patient records of adult utilized DBDs between 2013 and 2016 used 67 KIs to describe adherence to guidelines...
October 22, 2018: Journal of Critical Care
Paula G David-João, Murilo H Guedes, Álvaro Réa-Neto, Viviane B de Oliveira Chaiben, Cristina P Baena
PURPOSE: Evaluate current recommendation for the use of noninvasive ventilation (Bi-level positive airway pressure- BiPAP modality) in hypoxemic acute respiratory failure, excluding chronic obstructive pulmonary disease. METHODS: Electronic searches in MEDLINE, Web of Science, Clinical Trials, and The Cochrane Central Register of Controlled Clinical Trials. We searched for randomized controlled trials comparing BiPAP to a control group in patients with hypoxemic acute respiratory failure...
October 19, 2018: Journal of Critical Care
Amy M J O'Shea, Spyridon Fortis, Mary Vaughan Sarrazin, Jane Moeckli, W C Yarbrough, Heather Schacht Reisinger
PURPOSE: To evaluate mortality, length of stay, and inter-hospital transfer in the Veteran Health Administration (VHA) among low complexity Intensive Care Unit (ICU) patients. MATERIALS AND METHOD: Retrospective study of adult ICU admissions identified in VHA Medical SAS®; 2010-2015 at Veterans Affairs (VA) Medical Centers. Facilities classified by the Rural Urban Commuting Area code algorithm as large rural (referred to as rural) (N = 6) or urban (N = 33)...
October 19, 2018: Journal of Critical Care
Kay Choong See, Joo Wei Chua, Danielle Verstegen, Jeroen J G Van Merrienboer, Walther N Van Mook
PURPOSE: Echocardiography is increasingly being taught to intensive care unit residents. Current training methods require teachers to closely supervise trainees individually, and are time-intensive. To reduce the time burden, dyad training (training in pairs) under simulation conditions has been shown to be non-inferior to individual training. We aimed to validate these preliminary results for focused subcostal echocardiography (FSE), in an authentic clinical context. MATERIALS AND METHODS: We conducted a quasi-experimental study within a 20-bed medical intensive care unit from June 2016 to March 2017...
October 16, 2018: Journal of Critical Care
En-Pei Lee, Shao-Hsuan Hsia, Chung-Chi Huang, Kuo-Chin Kao, Oi-Wa Chan, Chia-Ying Lin, Ya-Ting Su, I-Meng Hu, Jainn-Jim Lin, Han-Ping Wu
PURPOSE: To compare systemic vascular resistance index (SVRI) as measured by invasive transpulmonary indicator dilution (TPID) and non-invasive Doppler-derived resistive index in septic patients. METHODS: We measured the snuffbox resistive index (SBRI) in both hands of septic patients who received hemodynamic monitoring by TPID prospectively. RESULTS: Thirty-six patients with septic shock were enrolled (median acute physiology and chronic health evaluation II score: 23; median age: 64 years)...
October 16, 2018: Journal of Critical Care
Shahnaz Mohammed Ayasrah
PURPOSE: To investigate pain levels and factors that are predictive of pain for mechanically ventilated patients during rest and during routine nursing procedures. MATERIAL AND METHODS: Pain levels were assessed using Behavioral Pain Scale (BPS) and physiological measures among 247 mechanically ventilated patients. RESULTS: At rest, 33.2% of patients suffered pain, with a BPS > 3; of these, 10% presented significant pain levels (BPS ≥ 5)...
October 13, 2018: Journal of Critical Care
David Canty, Jennifer Barth, Yang Yang, Nathan Peters, Andrew Palmer, Alistair Royse, Colin Royse
PURPOSE: Focused cardiac ultrasound (FCU) training in critical care is restricted by availability of instructors. Supervised training may be substituted by self-directed learning with an ultrasound simulator guided by automated electronic learning, enabling scalability. MATERIALS AND METHODS: We prospectively compared learning outcomes in novice critical care physicians after completion of a supervised one-and-a-half-day workshop model with a self-guided course utilizing a simulator over four weeks...
October 12, 2018: Journal of Critical Care
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