Journal of critical care
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Journal of critical care · Jun 2003
Clinical TrialA study of once-daily amikacin with low peak target concentrations in intensive care unit patients: pharmacokinetics and associated outcomes.
The aim of this study was to assess the pharmacokinetics of individualized amikacin single-dosage regimens targeting low peak serum concentrations in a population of intensive care unit (ICU) patients, and to describe the outcomes associated with this dosing strategy. ⋯ Amikacin dosage individualization with low peak target concentrations was successful for the 36 ICU patients. This dosing strategy was not associated with nephrotoxicity, but conclusions on clinical efficacy cannot be drawn from this limited study.
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Clear communication is imperative if teams in any industry expect to make improvements. An estimated 85% of errors across industries result from communication failures. ⋯ Implementing the daily goals form resulted in a significant improvement in the percent of residents and nurses who understood the goals of care for the day and a reduction in ICU LOS. The use of the daily goals form has broad applicability in acute care medicine.
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Journal of critical care · Jun 2003
Comparative StudyThe use of benchmarking to identify top performing critical care units: a preliminary assessment of their policies and practices.
To describe the policies and practices of intensive care units (ICUs) with good patient survival and highly efficient resource use and to identify relevant variables for future investigation. ⋯ Benchmarking can be used to identify ICUs with good patient survival and highly efficient resource use. The combination of policies and practices used by these units might improve resource use in other ICUs.
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Journal of critical care · Jun 2003
Circulating endotoxin and antiendotoxin antibodies during severe sepsis and septic shock.
The presence of circulating endotoxin is common during sepsis but its prognostic value is poor. We hypothesized that this lack of correlation with outcome could be related in part to the presence of circulating antiendotoxin antibodies. In a 14-bed medical intensive care unit, in an 821-bed tertiary teaching hospital, we prospectively assessed endotoxin and antiendotoxin antibodies in patients with severe sepsis or septic shock. ⋯ Circulating endotoxin was detectable among 9 of 17 patients on inclusion but neither the basal value nor sequential measurements correlated with outcome. These results suggest that during severe sepsis and septic shock, circulating endotoxin is a poor prognostic marker whereas the detection of an increase in IgM antiendotoxin antibody levels could identify survivors. This increase in IgM antibody levels could be attributed to a reactivation of the immune system.
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Journal of critical care · Jun 2003
Improving the utilization of medical crisis teams (Condition C) at an urban tertiary care hospital.
Serious clinical deterioration precedes most cardiopulmonary arrests, and there is evidence that organized responses to this deterioration may prevent a substantial proportion of in-hospital deaths. We aimed to increase the utilization of our medical crisis response team (Condition C) to impact this source of mortality. ⋯ Utilization of an important patient safety measure may be increased by focused interventions at an urban tertiary care hospital.