Journal of intensive care medicine
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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.
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J Intensive Care Med · Feb 2015
The effect of flow trigger on rapid shallow breathing index measured through the ventilator.
The rapid shallow breathing index (RSBI) has the best predictive value to assess readiness for weaning from mechanical ventilation. At many institutions, this index is conveniently measured without disconnecting the patient from the ventilator, but this method may be inaccurate. Because modern ventilators have a base flow in the flow trigger mode that may provide a substantial help to the patient, we hypothesized that the RSBI is significantly decreased when measured through the ventilator with flow trigger even without continuous positive airway pressure (CPAP) and pressure support (PS). ⋯ The RSBI measurement is significantly decreased by the base flow delivered through modern ventilators in the flow trigger mode. If RSBI is measured through the ventilator in the flow trigger mode, the difference should be considered when using RSBI to assess readiness for weaning from mechanical ventilation.
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J Intensive Care Med · Jan 2015
Comparative Study Observational StudyVideo laryngoscopy is associated with increased first pass success and decreased rate of esophageal intubations during urgent endotracheal intubation in a medical intensive care unit when compared to direct laryngoscopy.
To compare the complication rates of urgent endotracheal intubation (UEI) performed by pulmonary critical care medicine (PCCM) fellows and attending intensivists using a direct laryngoscope (DL) versus a video laryngoscope (VL) in a medical intensive care unit (MICU). ⋯ The use of the VL for UEI performed by PCCM fellows is associated with a reduction in the rate of esophageal intubation and difficult endotracheal intubation when compared to the use of the DL.