Journal of critical care
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Journal of critical care · Dec 2007
Adrenal exhaustion in septic patients with vasopressor dependency.
The use of low-dose corticosteroids for patients with septic shock who remain vasopressor dependent after adequate fluid resuscitation is recommended, but there is lack of agreement on how to diagnose relative adrenal insufficiency (RAI) and when to start steroid supplementation among these patients. This case series reports changes in cortisol concentrations during the course of vasopressor-dependent septic shock. ⋯ Adrenal function in the critically ill is a dynamic process, and an appropriate initial adrenal response does not preclude later development of RAI.
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Journal of critical care · Dec 2007
Adrenal insufficiency in early phase of pediatric acute lung injury/acute respiratory distress syndrome.
Adequate adrenal function is essential to survive critical illness. Several recent articles have reported the significant effect of adrenal insufficiency (AI) in patients with sepsis. However, the prevalence of AI in pediatric acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is so far still scanty. Thus, we elected to study its prevalence and its clinical outcome. ⋯ Our study demonstrated that the prevalence of AI was common in pediatric ALI/ARDS. These results would be an initial step to further study the impact of AI on clinical outcomes of these children in a larger scale.
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Journal of critical care · Dec 2007
Intensive care unit exposures for long-term outcomes research: development and description of exposures for 150 patients with acute lung injury.
Long-term follow-up studies in critical care have described survivors' outcomes, but provided less insight into the patient/disease characteristics and intensive care therapies ("exposures") associated with these outcomes. Such insights are essential for improving patients' long-term outcomes. This report describes the development of a strategy for comprehensively measuring relevant exposures for long-term outcomes research, and presents empiric results from its implementation. ⋯ Using a multistep, iterative process, a comprehensive and feasible exposure measurement strategy for long-term outcomes research was successfully developed and implemented.
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Journal of critical care · Dec 2007
Multicenter StudyQuality measurement at intensive care units: which indicators should we use?
This study was conducted to develop a set of indicators that measure the quality of care in intensive care units (ICU) in Dutch hospitals and to evaluate the feasibility of the registration of these indicators. ⋯ In this study, a set of 11 quality indicators for intensive care was defined based on literature research, expert opinion, and testing. The set gives a quick view of the quality of care in individual ICUs. The availability of a computerized data collection system is important for an acceptable workload.
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Journal of critical care · Dec 2007
Comparative StudyInterhospital transfer of critically ill patients: demographic and outcomes comparison with nontransferred intensive care unit patients.
We examined the association between access to intensive care services and mortality in a cohort of critically ill patients. ⋯ We found some evidence to suggest that differential access to intensive care services impacts mortality within this case mix of patients. These findings may have implications for current efforts to centralize and regionalize critical care services.