Journal of intensive care medicine
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J Intensive Care Med · Nov 2013
Review Case ReportsICU management of aneurysmal subarachnoid hemorrhage.
Aneurysmal subarachnoid hemorrhage (SAH) has very high morbidity and mortality rates. Optimal intensive care unit (ICU) management requires knowledge of the potential complications that occur in this patient population. ⋯ The ICU management of the patient with SAH can be particularly challenging and requires an awareness of all potential neurologic and medical complications and their urgent treatments.
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J Intensive Care Med · Nov 2013
Multicenter StudyThe GENESIS project (GENeralized Early Sepsis Intervention Strategies): a multicenter quality improvement collaborative.
Improved outcomes for severe sepsis and septic shock have been consistently observed with implementation of early best practice intervention strategies or the 6-hour resuscitation bundle (RB) in single-center studies. This multicenter study examines the in-hospital mortality effect of GENeralized Early Sepsis Intervention Strategies (GENESIS) when utilized in community and tertiary care settings. ⋯ Patients with severe sepsis and septic shock receiving the RB in community and tertiary hospitals experience similar and significant reductions in mortality and hospital length of stay. These findings remained consistent when examined in both before-and-after and concurrent analyses. Early sepsis intervention strategies are associated with 1 life being saved for every 7 treated.
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The quest to obtain an accurate way to predict success when weaning a patient from mechanical ventilation continues. The established parameters such as tidal volume (Vt), respiratory rate (f), negative inspiratory force (NIF), vital capacity (VC), and minute ventilation (V) have not predicted weaning accurately. The frequency-to-tidal volume ratio (f/Vt), or rapid shallow breathing index (RSBI) is a good predictor of weaning success if the value is low, but not when the value approximates 105. Because of the aforementioned, we decided to add 2 corrective factors to the RSBI. The first one was elastance index (EI = peak pressure/NIF) and the second one, the ventilatory demand index (VDI = minute ventilation/10). The result of the product of the RSBI × EI × VDI was called the weaning index (WI). ⋯ The WI is a simple and reproducible parameter that integrates breathing pattern, compliance, inspiratory muscle strength, and ventilatory demand and is the most accurate predictor of weaning success.
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The treatment of sepsis is an ongoing challenge for clinicians; despite the wide choice of effective antibiotics to treat infection, sepsis remains the leading cause of morbidity and mortality for patients admitted to an intensive care unit. Dysregulation of the immune response is now recognized to be a key factor in multiple organ dysfunction, yet our therapy for inflammation remains ineffective. It has been advocated for more than a decade that cytokine reduction in blood compartment could lead to a reduction in mortality in sepsis. ⋯ In addition, new experimental systems that utilize human phagocytic cells and immobilized antibodies for targeted immunomodulation have emerged. In the context of limited resources and growing expansion in the availability of technologies, a better understanding of these therapies is required before they can be properly integrated into standard clinical practice in the hope of influencing major clinical outcomes. In this article, we will provide a concise overview of selected extracorporeal modalities currently in clinical use and briefly introduce some new promising techniques for sepsis.
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J Intensive Care Med · Sep 2013
Red cell distribution width and outcome in patients with septic shock.
Red cell distribution width (RDW) is reflective of systemic inflammation. The objective of this study was to investigate the association between RDW (on day 1 of development of septic shock) and mortality. ⋯ Red cell distribution width on day 1 of septic shock is a robust predictor of mortality. The RDW is inexpensive and commonly measured. The RDW fared better than either APACHE II or SOFA, and the sum of RDW and APACHE II was a stronger predictor of mortality than either one alone.