Journal of critical care
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Journal of critical care · Jun 2007
Randomized Controlled TrialLowering of glucose in critical care: a randomized pilot trial.
Similar to cardiac surgery patients, medical-surgical critically ill patients may benefit from intensive insulin therapy. The objectives of this pilot trial were to evaluate the feasibility of a randomized trial of intensive insulin therapy with respect to (a) achieving target glucose values in the 2 ranges of 5 to 7 and 8 to 10 mmol/L and (b) uncovering problems with the protocol in anticipation of a larger trial. ⋯ In this pilot trial of ICU patients with high illness severity, glucose values were in the 2 target ranges only 40% of the time, using well-accepted initiation and maintenance insulin infusion algorithms. A large randomized trial of glycemic control is feasible in this population to examine clinically important outcomes, but will require refined insulin algorithms and more comprehensive behavior change strategies to achieve target values.
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Journal of critical care · Jun 2007
Early evolution of arterial oxygenation in severe community-acquired pneumonia: a prospective observational study.
Acute respiratory failure requiring mechanical ventilation in severe community-acquired pneumonia has been shown to be a significant negative prognostic factor. We analyzed the early evolution of the Pao(2)/Fio(2) ratio and evaluated its clinical value as an outcome predictor. ⋯ A progressive improvement of Pao(2)/Fio(2) ratio during the first 48 hours of mechanical ventilation indicates favorable outcome. Serial measurement of this ratio should be considered in decision making for therapeutic strategy.
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Journal of critical care · Jun 2007
Multicenter StudyAnalysis of physiologic alterations in intensive care unit patients and their relationship with mortality.
To analyze patient physiologic alterations (events) and multiple organ failure during intensive care unit (ICU) stay and examine their relationship with ICU mortality. ⋯ Routinely gathered ICU data on physiologic variables and multiple organ failure can offer considerable complementary information not provided by usual mortality prediction systems; and their weight in daily care policy decisions may need to be revisited.
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Journal of critical care · Jun 2007
Multicenter Study Comparative StudyBarriers to implementing the Leapfrog Group recommendations for intensivist physician staffing: a survey of intensive care unit directors.
The Leapfrog Group, representing a consortium of health care purchasers, has promoted standards for intensive care unit (ICU) staffing in nonrural areas. The purpose of this study was to examine the perception of the Leapfrog standards among ICU directors and determine the potential barriers to implementing these standards. ⋯ Numerous barriers exist to implementing the Leapfrog recommendations for intensivist staffing, not the least of which is the lack of an ICU director in many hospitals. Better strategies are needed to overcome these barriers before the widespread adoption of an intensivist care model similar to Leapfrog is feasible.
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Journal of critical care · Jun 2007
Long-term outcomes in patients requiring stay of more than 48 hours in the intensive care unit following coronary bypass surgery.
The primary objective of this study was to determine the long-term outcomes of all patients requiring prolonged intensive care unit (ICU) stay following coronary bypass surgery (CABG) surgery. ⋯ Prolonged ICU stay following CABG resulted in increased early and late mortality and lower freedom from readmission to hospital for cardiac reasons.