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Critical Care Research and Practice

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https://www.readbyqxmd.com/read/27830088/impact-of-a-local-low-cost-ward-based-response-system-in-a-canadian-tertiary-care-hospital
#1
Andrea Blotsky, Louay Mardini, Dev Jayaraman
Background. Medical emergency teams (METs) or rapid response teams (RRTs) facilitate early intervention for clinically deteriorating hospitalized patients. In healthcare systems where financial resources and intensivist availability are limited, the establishment of such teams can prove challenging. Objectives. A low-cost, ward-based response system was implemented on a medical clinical teaching unit in a Montreal tertiary care hospital. A prospective before/after study was undertaken to examine the system's impact on time to intervention, code blue rates, and ICU transfer rates...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27822386/correlation-between-arterial-lactate-and-central-venous-lactate-in-children-with-sepsis
#2
Jaime Fernández Sarmiento, Paula Araque, María Yepes, Hernando Mulett, Ximena Tovar, Fabio Rodriguez
Introduction. Lactate is an important indicator of tissue perfusion. The objective of this study is to evaluate if there are significant differences between the arterial and central venous measurement of lactate in pediatric patients with sepsis and/or septic shock. Methods. Longitudinal retrospective observational study. Forty-two patients were included between the age of 1 month and 17 years, with a diagnosis of sepsis and septic shock, who were admitted to the intensive care unit of a university referral hospital...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27800179/clinical-characteristics-and-short-term-outcomes-of-hiv-patients-admitted-to-an-african-intensive-care-unit
#3
Arthur Kwizera, Mary Nabukenya, Agaba Peter, Lameck Semogerere, Emmanuel Ayebale, Catherine Katabira, Samuel Kizito, Cecilia Nantume, Ian Clarke, Jane Nakibuuka
Purpose. In high-income countries, improved survival has been documented among intensive care unit (ICU) patients infected with human immune deficiency virus (HIV). There are no data from low-income country ICUs. We sought to identify clinical characteristics and survival outcomes among HIV patients in a low-income country ICU. Materials and Methods. A retrospective cohort study of HIV infected patients admitted to a university teaching hospital ICU in Uganda. Medical records were reviewed. Primary outcome was survival to hospital discharge...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27795857/potentially-preventable-deaths-by-intensive-care-medicine-in-mongolian-hospitals
#4
Naranpurev Mendsaikhan, Tsolmon Begzjav, Ganbold Lundeg, Martin W Dünser
Purpose. To evaluate the portion of hospitalized patients dying without prior intensive care unit (ICU) admission and assess whether death could have been prevented by intensive care. Methods. In this prospective, observational, multicenter study, data of adults dying in and outside the ICU in 5 tertiary and 14 secondary hospitals were collected during six months. A group of experts categorized patients dying without prior ICU admission as whether their death was potentially preventable or not. Results. 617 patients died (72...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27721991/abnormal-admission-chest-x-ray-and-mews-as-icu-outcome-predictors-in-a-sub-saharan-tertiary-hospital-a-prospective-observational-study
#5
Hannington Ssemmanda, Tonny Stone Luggya, Clare Lubulwa, Zeridah Muyinda, Pascal Kwitonda, Humphrey Wanzira, Joseph Ejoku
Background. Critical care in Uganda is a neglected speciality and deemed costly with limited funding/prioritization. We studied admission X-ray and MEWS as mortality predictors of ICU patients requiring mechanical ventilation. Materials and Methods. We did a cross-sectional study in Mulago Hospital ICU and 87 patients for mechanical ventilation were recruited with mortality as the outcome of interest. Chest X-ray results were the main independent variable and MEWS was also gotten for all patients. Results. We recruited 87 patients; most were males (60...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27703807/the-development-of-intensive-care-unit-acquired-hypernatremia-is-not-explained-by-sodium-overload-or-water-deficit-a-retrospective-cohort-study-on-water-balance-and-sodium-handling
#6
M C O van IJzendoorn, H Buter, W P Kingma, G J Navis, E C Boerma
Background. ICU acquired hypernatremia (IAH, serum sodium concentration (sNa) ≥ 143 mmol/L) is mainly considered iatrogenic, induced by sodium overload and water deficit. Main goal of the current paper was to answer the following questions: Can the development of IAH indeed be explained by sodium intake and water balance? Or can it be explained by renal cation excretion? Methods. Two retrospective studies were conducted: a balance study in 97 ICU patients with and without IAH and a survey on renal cation excretion in 115 patients with IAH...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27688911/can-transcutaneous-co2-tension-be-used-to-calculate-ventilatory-dead-space-a-pilot-study
#7
Pradeep H Lakshminarayana, Adiba A Geeti, Umer M Darr, David A Kaufman
Dead space fraction (V d/V t) measurement performed using volumetric capnography requires arterial blood gas (ABG) sampling to estimate the partial pressure of carbon dioxide (PaCO2). In recent years, transcutaneous capnography (PtcCO2) has emerged as a noninvasive method of estimating PaCO2. We hypothesized that PtcCO2 can be used as a substitute for PaCO2 in the calculation of V d/V t. In this prospective pilot comparison study, 30 consecutive postcardiac surgery mechanically ventilated patients had V d/V t calculated separately using volumetric capnography by substituting PtcCO2 for PaCO2...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27642081/response-to-comment-on-management-of-atrial-fibrillation-in-critically-ill-patients
#8
COMMENT
Mattia Arrigo, Dominique Bettex, Alain Rudiger
No abstract text is available yet for this article.
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27641992/comment-on-management-of-atrial-fibrillation-in-critically-ill-patients
#9
COMMENT
Roger Jelliffe
No abstract text is available yet for this article.
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27555967/management-of-maternal-cardiac-arrest-in-the-third-trimester-of-pregnancy-a-simulation-based-pilot-study
#10
Jacquelyn Adams, Jose R Cepeda Brito, Lauren Baker, Patrick G Hughes, M David Gothard, Michele L McCarroll, Jocelyn Davis, Angela Silber, Rami A Ahmed
Objective. To evaluate confidence, knowledge, and competence after a simulation-based curriculum on maternal cardiac arrest in an Obstetrics & Gynecologic (OBGYN) residency program. Methods. Four simulations with structured debriefing focusing on high yield causes and management of maternal cardiac arrest were executed. Pre- and post-individual knowledge tests (KT) and confidence surveys (CS) were collected along with group scores of critical performance steps evaluated by content experts for the first and final simulations...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27516901/survey-of-oxygen-delivery-practices-in-uk-paediatric-intensive-care-units
#11
Sainath Raman, Samiran Ray, Mark J Peters
Purpose. Administration of supplemental oxygen is common in paediatric intensive care. We explored the current practice of oxygen administration using a case vignette in paediatric intensive care units (PICU) in the united kingdom. Methods. We conducted an online survey of Paediatric Intensive Care Society members in the UK. The survey outlined a clinical scenario followed by questions on oxygenation targets for 5 common diagnoses seen in critically ill children. Results. Fifty-three paediatric intensive care unit members from 10 institutions completed the survey...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27493799/determinants-of-deescalation-failure-in-critically-ill-patients-with-sepsis-a-prospective-cohort-study
#12
Nawal Salahuddin, Lama Amer, Mini Joseph, Alya El Hazmi, Hassan Hawa, Khalid Maghrabi
Introduction. Deescalation refers to either discontinuation or a step-down of antimicrobials. Despite strong recommendations in the Surviving Sepsis Guidelines (2012) to deescalate, actual practices can vary. Our objective was to identify variables that are associated with deescalation failure. Methods. In this prospective study of patients with sepsis/septic shock, patients were categorized into 4 groups based on antibiotic administration: no change in antibiotics, deescalation, escalation (where antibiotics were changed to those with a broader spectrum of antimicrobial coverage), or mixed changes (where both escalation to a broader spectrum of coverage and discontinuation of antibiotics were carried out)...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27433357/antimicrobial-doses-in-continuous-renal-replacement-therapy-a-comparison-of-dosing-strategies
#13
Anna P Kempke, Abbie S Leino, Farzad Daneshvar, John Andrew Lee, Bruce A Mueller
Purpose. Drug dose recommendations are not well defined in patients undergoing continuous renal replacement therapy (CRRT) due to limited published data. Several guidelines and pharmacokinetic equations have been proposed as tools for CRRT drug dosing. Dose recommendations derived from these methods have yet to be compared or prospectively evaluated. Methods. A literature search of PubMed, Micromedex, and Embase was conducted for 40 drugs commonly used in the ICU to gather pharmacokinetic data acquired from patients with acute and chronic kidney disease as well as healthy volunteers...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27375901/accuracy-of-transcutaneous-carbon-dioxide-measurement-in-premature-infants
#14
Marie Janaillac, Sonia Labarinas, Riccardo E Pfister, Oliver Karam
Background. In premature infants, maintaining blood partial pressure of carbon dioxide (pCO2) value within a narrow range is important to avoid cerebral lesions. The aim of this study was to assess the accuracy of a noninvasive transcutaneous method (TcpCO2), compared to blood partial pressure of carbon dioxide (pCO2). Methods. Retrospective observational study in a tertiary neonatal intensive care unit. We analyzed the correlation between blood pCO2 and transcutaneous values and the accuracy between the trends of blood pCO2 and TcpCO2 in all consecutive premature infants born at <33 weeks' gestational age...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27242924/immunocompromised-children-with-severe-adenoviral-respiratory-infection
#15
Joanna C Tylka, Michael C McCrory, Shira J Gertz, Jason W Custer, Michael C Spaeder
Purpose. To investigate the impact of severe respiratory adenoviral infection on morbidity and case fatality in immunocompromised children. Methods. Combined retrospective-prospective cohort study of patients admitted to the intensive care unit (ICU) in four children's hospitals with severe adenoviral respiratory infection and an immunocompromised state between August 2009 and October 2013. We performed a secondary case control analysis, matching our cohort 1 : 1 by age and severity of illness score with immunocompetent patients also with severe respiratory adenoviral infection...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27200187/additional-analgesia-for-central-venous-catheter-insertion-a-placebo-controlled-randomized-trial-of-dexmedetomidine-and-fentanyl
#16
Aloka Samantaray, Mangu Hanumantha Rao, Chitta Ranjan Sahu
We aimed to show that a single preprocedural dose of either dexmedetomidine or fentanyl reduces procedural pain and discomfort and provides clinically acceptable sedation. In this prospective, double-blind study, sixty patients scheduled for elective surgery and requiring planned central venous catheter insertion were randomized to receive dexmedetomidine (1 μg/kg), fentanyl (1 μg/kg), or 0.9% normal saline intravenously over ten minutes followed by local anesthetic field infiltration before attempting central venous catheterization...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27195148/neutropenic-sepsis-in-the-icu-outcome-predictors-in-a-two-phase-model-and-microbiology-findings
#17
Jan M Kruse, Thomas Jenning, Sibylle Rademacher, Renate Arnold, Clemens A Schmitt, Achim Jörres, Philipp Enghard, Michael Oppert
Objective. Patients with neutropenic sepsis have a poor prognosis. We aimed to identify outcome predictors and generate hypotheses how the care for these patients may be improved. Methods. All 12.352 patients admitted between 2006 and 2011 to the medical ICUs of our tertiary university center were screened for neutropenia; out of 558 patients identified, 102 fulfilled the inclusion criteria and were analyzed. Severity markers and outcome predictors were assessed. Results. The overall ICU mortality was 54.9%...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27127648/applicability-of-pulse-pressure-variation-during-unstable-hemodynamic-events-in-the-intensive-care-unit-a-five-day-prospective-multicenter-study
#18
Bertrand Delannoy, Florent Wallet, Delphine Maucort-Boulch, Mathieu Page, Mahmoud Kaaki, Mathieu Schoeffler, Brenton Alexander, Olivier Desebbe
Pulse pressure variation can predict fluid responsiveness in strict applicability conditions. The purpose of this study was to describe the clinical applicability of pulse pressure variation during episodes of patient hemodynamic instability in the intensive care unit. We conducted a five-day, seven-center prospective study that included patients presenting with an unstable hemodynamic event. The six predefined inclusion criteria for pulse pressure variation applicability were as follows: mechanical ventilation, tidal volume >7 mL/kg, sinus rhythm, no spontaneous breath, heart rate/respiratory rate ratio >3...
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27110396/comment-on-sedative-and-analgesic-effects-of-entonox-gas-compared-with-midazolam-and-fentanyl-in-synchronized-cardioversion
#19
Henrique Horta Veloso
No abstract text is available yet for this article.
2016: Critical Care Research and Practice
https://www.readbyqxmd.com/read/27073695/achievement-of-vancomycin-therapeutic-goals-in-critically-ill-patients-early-individualization-may-be-beneficial
#20
Bita Shahrami, Farhad Najmeddin, Sarah Mousavi, Arezoo Ahmadi, Mohammad Reza Rouini, Kourosh Sadeghi, Mojtaba Mojtahedzadeh
Objective. The aim of our study was to assess and validate the effectiveness of early dose adjustment of vancomycin based on first dose monitoring in achieving target recommended goal in critically ill patients. Methods. Twenty critically ill patients with sepsis received loading dose of 25 mg/kg of vancomycin and then were randomly assigned to 2 groups. Group 1 received maximum empirical doses of vancomycin of 15 mg/kg every 8 hrs. In group 2, the doses were individualized based on serum concentrations of vancomycin...
2016: Critical Care Research and Practice
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