Journal of intensive care medicine
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J Intensive Care Med · Nov 2014
Observational StudyFever after rewarming: incidence of pyrexia in postcardiac arrest patients who have undergone mild therapeutic hypothermia.
Induction of mild therapeutic hypothermia (TH; temperature 32-34°C) has become standard of care in many hospitals for comatose survivors of cardiac arrest. Pyrexia, or fever, is known to be detrimental in patients with neurologic injuries such as stroke or trauma. The incidence of pyrexia in the postrewarming phase of TH is unknown. We attempted to determine the incidence of fever after TH and hypothesized that those patients who were febrile after rewarming would have worse clinical outcomes than those who maintained normothermia in the postrewarming period. ⋯ Among a cohort of patients who underwent mild TH after OHCA, more than half of these patients developed pyrexia in the first 24 hours after rewarming. Although there were no significant differences in outcomes between febrile and nonfebrile patients identified in this study, these findings should be further evaluated in a larger cohort. Future investigations may be needed to determine whether postrewarming temperature management will improve the outcomes in this population.
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J Intensive Care Med · Sep 2014
Case ReportsA patient with trauma having cavitary pulmonary nodules: should further workup be pursued?
Traumatic pulmonary pseudocysts (TPPs) are rare sequelae of blunt chest trauma and may be incidentally visualized on initial, or subsequent, chest imaging. ⋯ The TPPs may be discovered on imaging shortly after blunt chest trauma and, in asymptomatic individuals, can often be monitored with observation and serial imaging.
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J Intensive Care Med · Sep 2014
Mutual agreement between providers in intensive care medicine on patient care after interdisciplinary rounds.
Insights regarding the results of interdisciplinary communication about patient care are limited. We explored the perceptions of intensivists, junior physicians, and nurses about patient care directly after the interdisciplinary rounds (IDRs) in the intensive care unit (ICU) to determine mutual agreement. ⋯ The recommendation of IDRs without mutual agreement in important aspects of patient care hampers safety in daily practice. This study demonstrates that a survey to determine this agreement between the intensivists, junior physicians, and ICU nurses has low agreement, as measured directly after the IDRs.
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J Intensive Care Med · Sep 2014
Review Case ReportsChiari syndrome and respiratory failure: a literature review.
Patients with failed extubation requiring reintubation have increased morbidity and mortality. This situation may reflect the severity of the underlying disorder or may reflect an undiagnosed condition that was not apparent at the time of the initial intubation. ⋯ Patients with CMs can have repeated extubation failures. Some of these patients have normal neurological examinations and studies and are not identified until they have an MRI study. Clinicians need to consider this possibility in patients who are difficult to wean.
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Intraabdominal infections are frequent and dangerous entity in intensive care units. Mortality and morbidity are high, causes are numerous, and treatment options are variable. ⋯ Current research describes a wide heterogeneity of patient populations, making it difficult to suggest a general treatment regimen and stressing the need of an individualized approach to decision making. Early focus-oriented intervention and antibiotic coverage tailored to the individual patient and hospital is warranted.