Journal of critical care
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Journal of critical care · Feb 2011
Toward optimal display of physiologic status in critical care: I. Recreating bedside displays from archived physiologic data.
Physiologic data display is essential to decision making in critical care. Current displays echo first-generation hemodynamic monitors dating to the 1970s and have not kept pace with new insights into physiology or the needs of clinicians who must make progressively more complex decisions about their patients. The effectiveness of any redesign must be tested before deployment. Tools that compare current displays with novel presentations of processed physiologic data are required. Regenerating conventional physiologic displays from archived physiologic data is an essential first step. ⋯ We present Multi Wave Animator (MWA) framework--a set of open source MATLAB (MathWorks, Inc., Natick, MA, USA) scripts aimed to create dynamic visualizations (eg, video files in AVI format) of patient vital signs recorded from bedside (intensive care unit or operating room) monitors. Multi Wave Animator creates animations in which vital signs are displayed to mimic their appearance on current bedside monitors. The source code of MWA is freely available online together with a detailed tutorial and sample data sets.
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Journal of critical care · Feb 2011
Reduced mortality after the implementation of a protocol for the early detection of severe sepsis.
We evaluate the impact that implementing an in-hospital protocol for the early detection of sepsis risk has on mortality from severe sepsis/septic shock. ⋯ The early detection of sepsis promoted early treatment, reducing in-hospital mortality from severe sepsis/septic shock.
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Journal of critical care · Feb 2011
Prognostic value of serum zinc levels in critically ill patients.
We investigated the hypothesis that a decline in serum zinc concentrations among critically ill patients is related to mortality, length of stay in the intensive care unit, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment (SOFA) scores. ⋯ The result of this study supports the fact that organ failure and critical illness lead to a decline in serum zinc concentrations and that administration of zinc may be beneficial for critically ill patients.
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Journal of critical care · Feb 2011
Oxidative stress as a novel target in pediatric sepsis management.
Sepsis with secondary multisystem organ dysfunction syndrome is the leading cause of death in the pediatric intensive care unit. Increased reactive oxygen species may influence circulating and endothelial cells, contributing to inflammatory tissue injury and explaining the tissue hypoxia paradigm based on microvascular dysfunction. An impaired mitochondrial cellular oxygen utilization, rather than inadequate oxygen delivery, was claimed to play a more important role in the development of multisystem organ dysfunction syndrome. ⋯ Antioxidant supplementation currently in use lacks a mechanistic support. Specific pharmacologic targets, such as mitochondria or Nicotinamide Adenine Dinucleotide Phosphate-Oxidase (NADPH) oxidase system, need to be explored. Furthermore, the early recognition of oxidative damage in these seriously ill patients and the usefulness of oxidative stress biomarkers to define a cut point for more successful therapeutic antioxidant interventions to be instituted would offer a new strategy to improve the outcome of critically ill children.
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Journal of critical care · Feb 2011
Effect of a quality improvement intervention to decrease delays in antibiotic delivery in pediatric febrile neutropenia: a pilot study.
Guidelines recommend the early (less than 1 hour) initiation of antibiotics for patients with severe sepsis. We hypothesize that a simple quality improvement intervention, leaving the first dose of broad-spectrum antibiotics available in the emergency cart, decreases the time to delivery of antibiotics and reduces medical complications in pediatric oncologic patients with febrile neutropenia. ⋯ Our results suggest that simple interventions can reduce time to antibiotic administration in a selected group of patients in a pediatric intensive care unit.