Journal of intensive care medicine
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J Intensive Care Med · Feb 2015
ReviewDo clinical parameters predict first planned extubation outcome in the pediatric intensive care unit?
There is absence of evidence-based guidelines to determine extubation readiness in the pediatric intensive care unit (PICU). ⋯ Physician judgment to determine extubation readiness led to a first planned extubation success rate of 91%. Age and the length of MV were primary risk factors for failed extubation. In patients with ≤1 day of MV, our findings suggest that confidence in extubation readiness following weaning to low ventilator rates may not be justified. Furthermore, reliance on preextubation ventilator settings and blood gas results to determine extubation readiness may lead to unnecessary prolongation of MV, thereby increasing the PICU LOS and excess cost. These findings are hypothesis generating and require further study for confirmation.
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J Intensive Care Med · Feb 2015
ReviewIntracerebral hemorrhage in patients receiving oral anticoagulation therapy.
Intracerebral hemorrhage (ICH) in patients with oral anticoagulation therapy is an increasingly prevalent problem in large part due to the aging population and the increased use of anticoagulants for patients at high risk of thrombosis. Warfarin has been virtually the only outpatient anticoagulant choice until fairly recently. The development of subcutaneously injected heparinoids, and more recently, of direct thrombin inhibitors, has made the treatment and prognostication of ICH in anticoagulated patients more difficult. ⋯ We review the evidence of the 4 major reversal agents for warfarin, vitamin K, prothrombin complex concentrates, activated factor VII, and fresh frozen plasma as well as rational treatment choices. We offer possible treatments for the newer anticoagulants based on the limited evidence available. Finally, we review recommendations from the major societies and studies that support early and aggressive therapies in intensive care units with dedicated neurological specialists.
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J Intensive Care Med · Feb 2015
Comparative StudyBrain injury as a risk factor for fever upon admission to the intensive care unit and association with in-hospital case fatality: a matched cohort study.
To test the hypothesis that fever was more frequent in critically ill patients with brain injury when compared to nonneurological patients and to study its effect on in-hospital case fatality. ⋯ These data suggest that fever is a frequent occurrence after brain injury, and that it is independently associated with in-hospital case fatality.
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J Intensive Care Med · Feb 2015
Mortality risk prediction with an updated Acute Physiology and Chronic Health Evaluation II score in critically ill obstetric patients: a cohort study.
Acute Physiology and Chronic Health Evaluation II (APACHE II) score has shown low prognostic ability to predict death in the obstetric population. The objective of this study was to evaluate whether an updated form of the APACHE II score would perform better in predicting mortality in critically ill obstetric patients. ⋯ The APACHE II overestimates mortality in the sample population. The updated APACHE II model predicts mortality more accurately in the obstetric population. This formula may be useful in adapting the existing APACHE II to current mortality risk in obstetric critical care populations.
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J Intensive Care Med · Feb 2015
Case ReportsSuccessful use of extracorporeal membrane oxygenation in an adult patient with toxic shock-induced heart failure.
Cardiomyopathy secondary to toxic shock syndrome (TSS) is an uncommon but potentially life-threatening problem. We report the case of a 51-year-old male who presented with profound cardiogenic shock and multiorgan failure that could not be managed by conventional therapy with intravenous fluids, vasopressors and inotropes. ⋯ The patient recovered from multiorgan failure, and left ventricular ejection fraction improved from <10% pre-ECMO to 65% 8 months after discharge. This case supports the view that VA ECMO can be used successfully to support vital organ perfusion in patients with profound but reversible cardiomyopathy attributed to TSS.