Journal of critical care
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Journal of critical care · Sep 2010
The "fever workup" and respiratory culture practice in critically ill trauma patients.
Fever and leukocytosis (FAL) in critically ill patients often triggers a "workup" that includes a respiratory secretion culture (RCx). We evaluated our respiratory culture practice associated with FAL. We hypothesized that FAL would be associated with a RCx, but would not be associated with a positive culture or treating a respiratory infection in critically injured patients during their first 14 intensive care unit (ICU) days. ⋯ Fever and leukocytosis were associated with the decision to obtain RCxs but were not associated with positive RCxs in our ICU practice. Respiratory secretion culture results had a low specificity and did not consistently impact treatment decisions. Factors other than fever and leukocytosis alone should influence the decision to obtain RCxs during the first 14 days in the ICU after trauma.
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Journal of critical care · Sep 2010
The effect of comorbidity and age on hospital mortality and length of stay in patients with sepsis.
Sepsis is believed to be responsible for substantial health care burden, but there is limited information about its magnitude and the factors affecting health outcomes in Asian population. The aim of the study was to assess the disease burden of sepsis and to test the usefulness of Charlson Comorbidity Index (CCI) and age as risk-adjusted hospital mortality predictors in patients with sepsis using hospital administrative database. ⋯ The sepsis-related mortality and resource utilization are high in this population as well. Comorbidities and advanced age were some of the most important contributors to hospital mortality and resource utilization.
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Journal of critical care · Sep 2010
The use of sodium-chloride difference and chloride-sodium ratio as strong ion difference surrogates in the evaluation of metabolic acidosis in critically ill patients.
Inorganic apparent strong ion difference (SIDai) improves chloride-associated acidosis recognition in dysnatremic patients. We investigated whether the difference between sodium and chloride (Na(+)-Cl(-)) or the ratio between chloride and sodium (Cl(-)/Na(+)) could be used as SIDai surrogates in mixed and dysnatremic patients. ⋯ Na(+)-Cl(-) and Cl(-)/Na(+) are good tools to disclose SIDai acidosis. In patients with dysnatremia, Na(+)-Cl(-) is an accurate tool to diagnose SIDai acidosis.
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The study was undertaken to evaluate the quality of life of survivors of septic illness. ⋯ Individuals surviving sepsis may have problems with physical, sensory, emotional, and cognitive functioning that become most apparent when involved in more challenging activities, such as working.
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Journal of critical care · Sep 2010
Does the time of onset of severe sepsis in a surgical intensive care unit influence mortality rates: a single-center retrospective analysis.
The purpose of this study was to investigate possible differences in characteristics and mortality rates between early- and late-onset severe sepsis in surgical intensive care unit (ICU) patients. ⋯ Patterns of infection are different in patients with early-onset and those with late-onset severe sepsis. The time of onset of severe sepsis in surgical ICU patients has no impact on mortality. These data may be important in risk stratification and may be useful in resource allocation in the ICU.