Journal of intensive care medicine
-
J Intensive Care Med · Jul 2020
Multicenter StudyThe Association Between Sequential Organ Failure Assessment Scores and Mortality in Patients With Sepsis During the First Week: The JSEPTIC DIC Study.
Predicting prognosis is a complex process, particularly in patients with severe sepsis or septic shock. This study aimed to determine the relationship between the Sequential Organ Failure Assessment (SOFA) scores for individual organs during the first week of admission and the in-hospital mortality in patients with sepsis. ⋯ The CNS SOFA scores were associated with mortality in patients with severe sepsis on days 1, 3, and 7 following hospitalization. The coagulation SOFA score was associated with mortality on day 7. In clinical situations, the CNS SOFA scores during the acute phase and the CNS SOFA and coagulation SOFA scores during the subsequent phases should be evaluated in order to determine patient prognosis.
-
J Intensive Care Med · Jul 2020
Carotid Flow as a Surrogate for Cardiac Output Measurement in Hemodynamically Stable Participants.
Evaluation of common carotid artery (CCA) blood flow can provide valuable information regarding the hemodynamic status of a patient. Utilizing ultrasound, we aimed to evaluate the correlation between cardiac output and different hemodynamic parameters in the CCA, namely systolic carotid flow (SCF), corrected flow time (CFT), and total carotid flow (TCF). ⋯ Variations in cardiac preload and the subsequent alterations in cardiac output were directly translatable into variations in the carotid blood flow. This supports the potential for using carotid flow as a surrogate for cardiac output. The most promising parameters were SCF, CFT, and carotid systolic VTI. Further work is needed to validate these correlations and utilize these acquired carotid parameters to guide fluid management and predict fluid responsiveness.
-
J Intensive Care Med · Jun 2020
Clinical Outcomes of Weight-Based Norepinephrine Dosing in Underweight and Morbidly Obese Patients: A Propensity-Matched Analysis.
Weight-based dosing strategy for norepinephrine in septic shock patients with extremes of body mass index has been lesser studied. ⋯ Morbidly obese patients had lower in-hospital mortality but had higher 1-year mortality compared to normal weight and underweight patients. Cumulative norepinephrine exposure was highest in morbidly obese patients. Total norepinephrine exposure was an independent mortality predictor in septic shock.
-
J Intensive Care Med · Jun 2020
Comparative StudyComparison of Ketamine- Versus Nonketamine-Based Sedation on Delirium and Coma in the Intensive Care Unit.
At this time, there are no studies evaluating the risk of delirium or coma with the use of ketamine in mechanically ventilated adult patients, compared to conventional therapies such as propofol or dexmedetomidine. ⋯ Sustained ketamine-based sedation in mechanically ventilated patients may be associated with a higher rate of observed coma but similar delirium- and coma-free days compared nonketamine-based regimens.
-
J Intensive Care Med · Jun 2020
Observational StudyAnalysis of Rothman Index Data to Predict Postdischarge Adverse Events in a Medical Intensive Care Unit.
Currently, there are no objective metrics included in the intensive care unit (ICU) discharge decision making process. In this study, we evaluate Rothman Index(RI) data for a possible metric as part of a quality improvement project. Our objectives were to determine whether RI could predict adverse events occurring within 72 hours of ICU discharge decision, the optimal clinical cutoff value for this metric, and to determine whether there is a relation between the RI warning alert 24 hours prior to discharge and adverse events postdischarge. ⋯ Patients who have an RI < 50 or a very high-risk warning alert have a higher risk of adverse events postdischarge from the ICU. Rothman Index may be a useful metric for ICU discharge decision-making.