Journal of critical care
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Journal of critical care · Feb 2011
Red blood cell transfusions--are we narrowing the evidence-practice gap? An observational study in 5 Israeli intensive care units.
The aim of the study was to document transfusion practices in a cross section of general intensive care units (ICUs) in Israel and to determine whether current guidelines are being applied. ⋯ Our study showed that evidence-practice gaps continue to exist, and it appears that physician behavior is mainly driven by the absolute level of hemoglobin. Educational interventions focused on these factors are required to limit the widespread and often unnecessary use of this scarce and potentially harmful resource.
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Journal of critical care · Feb 2011
A European care bundle for management of ventilator-associated pneumonia.
Although there is a wealth of guidance concerning the management of patients with ventilator-associated pneumonia (VAP), compliance with recommendations concerning optimal treatment practices is highly variable. ⋯ Adoption of these care bundles should rationalize VAP management practices and facilitate the development of consistent and guideline-compliant care processes.
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Journal of critical care · Feb 2011
Is surgical airway necessary for airway management in deep neck infections and Ludwig angina?
Deep neck infections are potentially life-threatening conditions because of airway compromise. Management requires early recognition, antibiotics, surgical drainage, and effective airway control. The Surgical Education and Self-Assessment Program 12 states that awake tracheostomy is the treatment of choice for these patients. ⋯ Treatment of Ludwig angina and deep neck abscesses requires good clinical judgment. Patients with deep neck infections and symptoms of airway compromise may be safely managed with advanced airway control techniques.
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Journal of critical care · Feb 2011
Pulmonary embolism in critically ill patients receiving antithrombotic prophylaxis: a clinical-pathologic study.
The true incidence of pulmonary embolism (PE) in critically ill adult patients receiving antithrombotic prophylaxis is unknown, as well as the impact on the outcome. The aim of this study was to assess the incidence of PE in a surgical and medical intensive care unit and to evaluate the presence of risk factors that could be helpful in identifying patients at higher risk of missed diagnosis. ⋯ Despite thromboprophylaxis, critically ill patients remain at risk for PE; and because of the difficulty in diagnosing it clinically, the death certificate diagnosis of PE underestimates the problem.
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Journal of critical care · Feb 2011
Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis.
To prospectively evaluate the performance of procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) as percentage of baseline (POB) in predicting hospital survival, we studied 64 consecutive, postoperative patients with severe sepsis. ⋯ Prediction rules of decrease in PCT-POB on day 7 in combination with CRP-POB may serve to monitor efficacy and guide duration of therapy in critically ill patients.