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Admission criteria in intensive care unit

Hiroyuki Naruse, Junnichi Ishii, Hiroshi Takahashi, Fumihiko Kitagawa, Hideto Nishimura, Hideki Kawai, Takashi Muramatsu, Masahide Harada, Akira Yamada, Sadako Motoyama, Shigeru Matsui, Mutsuharu Hayashi, Masayoshi Sarai, Eiichi Watanabe, Hideo Izawa, Yukio Ozaki
BACKGROUND: The early prediction of acute kidney injury (AKI) can facilitate timely intervention and prevent complications. We aimed to understand the predictive value of urinary liver-type fatty-acid binding protein (L-FABP) levels on admission to medical (non-surgical) cardiac intensive care units (CICUs) for AKI, both independently and in combination with serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. METHODS: We prospectively investigated the predictive value of L-FABP and NT-proBNP for AKI in a large, heterogeneous cohort of patients treated in medical CICUs...
August 18, 2018: Critical Care: the Official Journal of the Critical Care Forum
José Moreira, Ariane Paixão, Juliana Oliveira, Waldir Jaló, Ofélio Manuel, Rafaela Rodrigues, Alexandra Oliveira, Leonardo Tinoco, João Lima, Beatriz Grinsztejn, Valdiléa G Veloso, André M Japiassú, Cristiane C Lamas
OBJECTIVES: To compare the discriminatory capacity of the quick Sequential Organ Failure Assessment (qSOFA) versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting 30-day mortality and intensive care unit (ICU) admission in patients with suspicion of infection at an HIV reference center. METHODS: Prospective cohort study including consecutive adult patients who had suspected infection and subsequently admitted to the medical ward. Variables related to qSOFA and SIRS were measured at admission...
August 14, 2018: Clinical Microbiology and Infection
George L Anesi, Vincent X Liu, Nicole B Gabler, M Kit Delgado, Rachel Kohn, Gary E Weissman, Brian Bayes, Gabriel J Escobar, Scott D Halpern
RATIONALE: Intensive care unit (ICU) capacity strain refers to the potential limits placed on an ICU's ability to provide high-quality care for all patients who may need it at a given time. Few studies have investigated how fluctuations in ICU capacity strain might influence care outside of the ICU. OBJECTIVE: To determine whether intensive care unit (ICU) capacity strain is associated with initial level of inpatient care and outcomes for emergency department (ED) patients being hospitalized for sepsis...
August 16, 2018: Annals of the American Thoracic Society
F F Girrbach, F Hilbig, M Michael, M Bernhard
BACKGROUND: A myriad of publications have contributed to an evidence-based approach to airway management in emergency services and admissions in recent years; however, it remains unclear which international registries on airway management in emergency medicine currently exist and how they are characterized concerning inclusion criteria, patient characteristics and definition of complications. METHODS: A systematic literature research was carried out in PubMed with respect to publications from 2007-2017...
August 13, 2018: Der Anaesthesist
Elham Hosseini, Mohsen Janghorbani
BACKGROUND: There is an ongoing discussion about the optimal diagnostic strategy for gestational diabetes mellitus (GDM). OBJECTIVE: To assess the magnitude of the association between GDM diagnosed with the one-step (International Association of Diabetes and Pregnancy Study Groups criteria) or two-step (Carpenter and Coustan criteria) approach and selected adverse pregnancy outcomes. SEARCH STRATEGY: Five electronic databases were searched up to October 2017 using Medical Subject Headings for each adverse outcome combined with the term "gestational diabetes...
August 12, 2018: International Journal of Gynaecology and Obstetrics
Roberta Troìa, Giulia Mascalzoni, Stefano Calipa, Ilaria Magagnoli, Francesco Dondi, Massimo Giunti
Objectives The current study was designed to evaluate the prevalence and prognostic significance of multi-organ dysfunction syndrome (MODS) in cats with sepsis. Methods Cats hospitalised in the intensive care unit of a veterinary university hospital with a diagnosis of sepsis were prospectively enrolled and divided according to disease severity and outcome (survivors; non-survivors). The feline acute patient physiological and laboratory evaluation (APPLE) scores were calculated upon admission, as previously described...
August 13, 2018: Journal of Feline Medicine and Surgery
Madelyn Batey, Jason Hecht, Cherise Callahan, Wendy Wahl
BACKGROUND: Falls are now the leading cause of trauma and represent the most common type of trauma in the elderly. The use of anticoagulants is increasing in older patients, but there are little data on outcomes after traumatic brain injury while anticoagulated with direct oral anticoagulants compared with warfarin. We hypothesized that anticoagulated patients would have a greater mortality and complications than nonanticoagulated patients, and patients on direct oral anticoagulants would have more fatal outcomes after low-level falls because of lack of reversal agents...
August 8, 2018: Surgery
Ayobami T Akenroye, Abayomi Ajala, Elham Azimi-Nekoo, Gabriele S de Vos
BACKGROUND: In asthmatics, making a diagnosis of anaphylaxis could be challenging as respiratory symptoms are a common feature of both conditions. Identifying anaphylaxis is important to providing appropriate care. A prior study showed that anaphylaxis is sometimes misdiagnosed as acute asthma in children. We sought to identify the percentage of adults admitted to the intensive care unit (ICU) with asthma exacerbations who met criteria for anaphylaxis. METHODS: Retrospective chart review of adults admitted with acute asthma to the ICU at Jacobi Medical Center, a Level 1 trauma centre in Bronx, New York...
August 9, 2018: Emergency Medicine Journal: EMJ
Katrina Dunn, Anna Rumbach
The aim of the study is to investigate dysphagia incidence and establish factors which may reliably predict dysphagia risk in individuals presenting with non-traumatic subarachnoid hemorrhage (SAH). A retrospective chart audit of 250 patients (151 females and 99 males) consecutively admitted with non-traumatic SAH to a major, tertiary neurosurgery referral center in Australia was conducted. Demographics, medical, and surgical information, along with speech-language pathology (SLP) assessment data were collected...
August 7, 2018: Dysphagia
David Philip Inwald, Ruth Canter, Kerry Woolfall, Paul Mouncey, Zohra Zenasni, Caitlin O'Hara, Anjali Carter, Nicola Jones, Mark D Lyttle, Simon Nadel, Mark J Peters, David A Harrison, Kathryn M Rowan
OBJECTIVE: To determine the feasibility of Fluids in Shock, a randomised controlled trial (RCT) of restricted fluid bolus volume (10 mL/kg) versus recommended practice (20 mL/kg). DESIGN: Nine-month pilot RCT with embedded mixed-method perspectives study. SETTING: 13 hospitals in England. PATIENTS: Children presenting to emergency departments with suspected infection and shock after 20 mL/kg fluid. INTERVENTIONS: Patients were randomly allocated (1:1) to further 10 or 20 mL/kg fluid boluses every 15 min for up to 4 hours if still in shock...
August 7, 2018: Archives of Disease in Childhood
Philip Yang, Perry Formanek, Steven Scaglione, Majid Afshar
AIM: Prior randomized controlled trials of acute respiratory distress syndrome (ARDS) excluded critically ill patients with cirrhosis. Data regarding risk factors for ARDS development and outcomes from ARDS in patients with cirrhosis are scarce. We sought to characterize outcomes from ARDS in patients with cirrhosis. METHODS: An observational cohort of patients with cirrhosis admitted to an intensive care unit (ICU) at a high-volume liver transplant center between January 1, 2012 and December 31, 2014 were reviewed...
August 7, 2018: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Morgan Schellenberg, Kenji Inaba, Vincent Cheng, James M Bardes, Patrick Heindel, Kazuhide Matsushima, Elizabeth Benjamin, Demetrios Demetriades
BACKGROUND: Atlanto-occipital dissociation (AOD) occurs when the skull base is forcibly separated from the vertebral column. Existing literature on AOD is sparse and risk factors for mortality are unknown. This study determined independent predictors of survival after AOD. METHODS: Patients who sustained AOD were identified from the National Trauma Data Bank (2007-2014). Those arriving without signs of life or with missing mortality data were excluded. Study groups were defined as patients who survived to hospital discharge versus patients who died in hospital...
August 2018: Journal of Trauma and Acute Care Surgery
Norman J Galbraith, Stephen J O'Brien, Samuel P Walker, Sarah A Gardner, Hiram C Polk, Stephen L Barnes
BACKGROUND: Severe injury can lead to immune dysfunction and predispose patients to infection and death. Micro-RNAs regulate gene expression and may act as biomarkers for susceptibility to infection. The aim of this study was to examine the temporal and differential expression of previously identified dysregulated micro-RNAs in patients with severe injury. METHODS: Fourteen severely injured patients requiring transfusion were enrolled prospectively in this study approved by our institutional review board...
August 1, 2018: Surgery
Esther Peters, Massimo Antonelli, Xavier Wittebole, Rahul Nanchal, Bruno François, Yasser Sakr, Jean-Louis Vincent, Peter Pickkers
BACKGROUND: Acute kidney injury (AKI) is a common complication of critical illness and is associated with worse outcomes. However, the influence of deterioration or improvement in renal function on clinical outcomes is unclear. Using a large international database, we evaluated the prevalence and evolution of AKI over a 7-day period and its effects on clinical outcomes in septic and non-septic critically ill patients worldwide. METHODS: From the 10,069 adult intensive care unit (ICU) patients in the Intensive Care Over Nations database, all those with creatinine and urine output data were included in this substudy...
August 3, 2018: Critical Care: the Official Journal of the Critical Care Forum
Samuel A Merrill, Rakhi Naik, Michael B Streiff, Satish Shanbhag, Sophie Lanzkron, Evan M Braunstein, Alison M Moliterno, Robert A Brodsky
Hemophagocytic lymphohistiocytosis (HLH) is a highly fatal, hyperinflammatory syndrome in adults triggered by an underlying illness in most cases. As such, suspicion of HLH dictates further investigation to identify the HLH trigger and determine treatment. HLH is clinically challenging due to diverse presentations and underlying triggers, provider unfamiliarity, and bleeding complications. Clinically, we observed diagnostic error from incorrect testing and cognitive biases (interleukin-2 confused with soluble interleukin-2 receptor and natural killer cell quantification confused with functional assays)...
August 2018: Medicine (Baltimore)
Steen K Fagerberg, Parth Patel, Lars W Andersen, Xiaowen Lui, Michael W Donnino, Helle A Praetorius
BACKGROUND: Pore-forming proteins released from bacteria or formed as result of complement activation are known to produce severe cell damage. Inhibition of purinergic P2X receptors markedly reduces damage inflicted by cytolytic bacterial toxin and after complement activation in both erythrocytes and monocytes. P2X expression generally shows variation throughout the population. Here, we investigate correlation between P2X receptor abundance in blood cell plasma membranes and haematocrit during sepsis, in patients admitted to the emergency department (ED) or intensive care unit (ICU)...
August 2, 2018: Critical Care: the Official Journal of the Critical Care Forum
Kathleen M O'Connell, D Alex Quistberg, Robert Tessler, Bryce R H Robinson, Joseph Cuschieri, Ronald V Maier, Frederick P Rivara, Monica S Vavilala, Paul I Bhalla, Saman Arbabi
OBJECTIVE: The aim of this study was to examine the risk of delirium in geriatric trauma patients with rib fractures treated with systemic opioids compared with those treated with regional analgesia (RA). SUMMARY OF BACKGROUND DATA: Delirium is a modifiable complication associated with increased morbidity and mortality. RA may reduce the need for opioid medications, which are associated with delirium in older adults. METHODS: Cohort study of patients ≥65 years admitted to a regional trauma center from 2011 to 2016...
September 2018: Annals of Surgery
Niklas Bobrovitz, Carl Heneghan, Igho Onakpoya, Benjamin Fletcher, Dylan Collins, Alice Tompson, Joseph Lee, David Nunan, Rebecca Fisher, Brittney Scott, Jack O'Sullivan, Oliver Van Hecke, Brian D Nicholson, Sarah Stevens, Nia Roberts, Kamal R Mahtani
BACKGROUND: Rates of emergency hospitalisations are increasing in many countries, leading to disruption in the quality of care and increases in cost. Therefore, identifying strategies to reduce emergency admission rates is a key priority. There have been large-scale evidence reviews to address this issue; however, there have been no reviews of medication therapies, which have the potential to reduce the use of emergency health-care services. The objectives of this study were to review systematically the evidence to identify medications that affect emergency hospital admissions and prioritise therapies for quality measurement and improvement...
July 26, 2018: BMC Medicine
Boris Khodorkovsky, Elias Youssef, Frosso Adamakos, Tiffany Cina, Amanda Falco, Lauren LaMura, Anthony Marion, Samuel Nathan, Barry Hahn
BACKGROUND: Sepsis is a leading cause of morbidity and mortality in hospitalized patients. Prompt recognition and early treatment has been shown to improve mortality. Both low and high temperature are among the four elements of systemic inflammatory response required for the diagnosis of sepsis. We hypothesized that initial temperature has an effect on the identification, treatment, and outcomes of septic patients. OBJECTIVE: Our aim was to determine the prognostic and diagnostic utility of the initial recorded body temperature in patients presenting to the emergency department (ED) with sepsis...
July 21, 2018: Journal of Emergency Medicine
Filippo Annoni, Antonio Maria Dell'Anna, Federico Franchi, Jacques Creteur, Sabino Scolletta, Jean-Louis Vincent, Fabio Silvio Taccone
AIM: Which haemodynamic variable is the best predictor of neurological outcome remains unclear. We investigated the association of several haemodynamic variables with neurological outcome in CA patients. METHODS: Retrospective analysis of adult comatose survivors of CA admitted to the intensive care unit (ICU) of a University Hospital. Exclusion criteria were early death due to withdrawal of care, missing haemodynamic data and use of intra-aortic balloon pump or extracorporeal membrane oxygenation...
July 19, 2018: Resuscitation
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