Journal of intensive care medicine
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J Intensive Care Med · Oct 2015
Review Meta AnalysisSystematic Review and Meta-Analysis of End-Tidal Carbon Dioxide Values Associated With Return of Spontaneous Circulation During Cardiopulmonary Resuscitation.
End-tidal carbon dioxide (ETCO(2)) measurements during cardiopulmonary resuscitation (CPR) reflect variable cardiac output over time, and low values have been associated with decreased survival. The goals of this review are to confirm and quantify this relationship and to determine the mean ETCO(2) value among patients with return of spontaneous circulation (ROSC) as an initial step toward determining an appropriate target for intervention during resuscitation in the absence of prospective data. ⋯ Participants with ROSC after CPR have statistically higher levels of ETCO(2). The average ETCO(2) level of 25 mm Hg in participants with ROSC is notably higher than the threshold of 10 to 20 mm Hg to improve delivery of chest compressions. The ETCO(2) goals during resuscitation may be higher than previously suggested and further investigation into appropriate targets during resuscitation is needed to diminish morbidity and mortality after cardiorespiratory arrest.
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J Intensive Care Med · Oct 2015
Multicenter Study Observational StudyCoefficient of Variation of Coarsely Sampled Heart Rate is Associated With Early Vasopressor Independence in Severe Sepsis and Septic Shock.
To determine whether variability of coarsely sampled heart rate and blood pressure early in the course of severe sepsis and septic shock predicts successful resuscitation, defined as vasopressor independence at 24 hours after admission. ⋯ Increased variability of coarsely sampled heart rate was associated with vasopressor independence at 24 hours after controlling for possible confounders. Sampling frequencies of once in 5 minutes may be similar to once in 30 seconds.
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J Intensive Care Med · Oct 2015
ReviewConnective Tissue Disease-Associated Interstitial Lung Disease: A Focused Review.
The connective tissue diseases (CTDs) are a group of systemic disorders characterized by autoimmunity and autoimmune-mediated organ damage. The lung is a frequent target and all components of the respiratory system are at risk. Interstitial lung disease (ILD) represents a broad group of diffuse parenchymal lung injury patterns characterized by varying degrees of inflammation and fibrosis, is a common manifestation of CTD particularly common in systemic sclerosis, polymyositis/dermatomyositis, and rheumatoid arthritis, and is a leading cause of significant morbidity and mortality. ⋯ Furthermore, patients with CTD are also at risk of acute exacerbations of underlying ILD. Acute exacerbations are manifested by subacute respiratory deterioration with worsening hypoxemia in the setting of new radiographic abnormalities. The prognosis of patients with CTD having respiratory failure is often quite poor, highlighting the need for prompt and thorough clinical assessments to determine the underlying etiology and implementation of appropriate therapeutic strategies.
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J Intensive Care Med · Oct 2015
Assessing the Influence of Intensive Care Unit Organizational Factors on Outcomes in Canada: Is There Residual Confounding?
To illustrate the complexities of assessing the influence of individual organizational factors on outcomes for intensive care unit (ICU) patients in Canada. ⋯ The lack of a consistent relationship between organizational factors and ICU outcomes, and relationships that show increased mortality associated with some advantageous factors, suggests that there is residual confounding in these relationships. Models that adjust for only conventional patient-level confounders are unlikely to provide valid estimates of the influence of organizational factors.
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J Intensive Care Med · Oct 2015
Characteristics and Outcomes of Ethics Consultations in an Oncologic Intensive Care Unit.
To evaluate the frequency, characteristics, and outcomes of ethics consultations in critically ill patients with cancer. ⋯ Our study showed that ethics consultations were helpful in resolving seemingly irreconcilable differences between the ICU team and the patients' surrogates in the majority of cases. Additionally, these consultations identified the need for an increased provision of palliative care and chaplaincy visits for patients and their surrogates at the end of life.