Journal of critical care
-
Journal of critical care · Oct 2013
Hypophosphatemia on the intensive care unit: Individualized phosphate replacement based on serum levels and distribution volume.
Hypophosphatemia occurs in about 25% of patients admitted to the intensive care unit. To date, a safe and validated phosphate replacement protocol is not available. ⋯ This study shows that phosphate replacement with dose calculation based on serum phosphate levels and a Vd of 0.5 L/kg is effective and safe.
-
Journal of critical care · Oct 2013
Measuring safety culture in Palestinian neonatal intensive care units using the Safety Attitudes Questionnaire.
This study aimed to measure safety culture, examine variations among neonatal intensive care units (NICUs), and assess the associations with caregiver characteristics. ⋯ We found large variations in safety culture within and between a comprehensive sample of Palestinian NICUs. The findings suggest the need for a customized approach that builds on existing strengths and targets areas of opportunities for improvement to optimize health care delivery to the most vulnerable of patients, sick newborns in the NICU setting.
-
Journal of critical care · Oct 2013
High glucose variability increases cerebral infarction in patients with spontaneous subarachnoid hemorrhage.
High glucose variability is a significant marker for poor outcome in critically ill patients. We evaluated the impact of high glucose variability on cerebral infarction following spontaneous subarachnoid hemorrhage (SAH). ⋯ Glucose variability is a significant predictor of cerebral infarction in patients with severe spontaneous SAH.
-
Journal of critical care · Oct 2013
Changing trends in the use of seizure prophylaxis after traumatic brain injury: A shift from phenytoin to levetiracetam.
Current guidelines for traumatic brain injury (TBI) recommend antiepileptic drugs (AEDs) for 7 days after injury to decrease posttraumatic seizure risk. Phenytoin decreases seizure risk 73% vs placebo during this time. Levetiracetam (LEV) is an alternative; however, no published data validate comparable efficacy. Our objective was to evaluate seizure incidence 7 days after TBI in patients treated with phenytoin (PHT) vs LEV and to characterize practice of AED selection. ⋯ Only 2 patients experienced posttraumatic seizure after receiving AED, indicating low incidence. Most surviving to hospital discharge received AED prophylaxis greater than 7 days despite guideline recommendations. After approval of intravenous LEV, a trend favoring LEV was observed.
-
Journal of critical care · Oct 2013
Continuous multiorgan variability analysis to track severity of organ failure in critically ill patients.
The purpose of this study is to evaluate the utility of using continuous heart rate variability (HRV) and respiratory rate variability (RRV) monitoring for (a) tracking daily organ dysfunction in critically ill patients and (b) identifying patterns of variability changes during onset of shock and resolution of respiratory failure. ⋯ There is an association between reduced HRV and RRV and increasing organ dysfunction in critically ill patients. The significance of observing trends of decreasing HRV (with onset of shock) and increasing RRV (with resolution of respiratory failure) merits further investigation.