Journal of critical care
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Journal of critical care · Oct 2013
Mean perfusion pressure deficit during the initial management of shock-an observational cohort study.
It is unclear if blood pressure targets for patients with shock should be adjusted to pre-morbid levels. We aimed to investigate mean deficit between the achieved mean perfusion pressure (MPP) in vasopressor-treated patients and their estimated basal (resting) MPP, and assess whether MPP deficit has any association with subsequent acute kidney injury (AKI). ⋯ Achieved blood pressure during vasopressor therapy had no relationship to the pre-morbid basal level. This resulted in significant and varying degree of relative hypotension (MPP deficit), which could be a modifiable risk factor for AKI in patients with shock.
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Journal of critical care · Oct 2013
Multicenter StudyPrevalence of acute kidney injury in intensive care units: The "COrte de prevalencia de disFunción RenAl y DEpuración en críticos" point-prevalence multicenter study.
This study aimed to measure the point prevalence of kidney dysfunction (KD) in the intensive care setting. ⋯ Each day of study, more that half of the patients admitted to the ICU showed some derangement in kidney function. More than 25% of patients not fulfilling the KD criteria by serum creatinine or acute kidney injury network showed, in fact, a severe KD, and this finding was associated with higher mortality. More than 50% of the patients admitted to the ICU were subjected to at least 1 renal insult.
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Journal of critical care · Oct 2013
Impact of older age and nursing home residence on clinical outcomes of US emergency department visits for severe sepsis.
The purpose of this study is to compare the impact of older age and nursing home residence on the incidence and morbidity of severe sepsis. ⋯ Older adults and particularly nursing home residents have a disproportionately high incidence of and morbidity from severe sepsis.
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Journal of critical care · Oct 2013
ReviewReporting the methodology of height and weight acquisition in studies of body mass index-based prognosis in critically ill patients.
Conflicting findings were reported on the body mass index (BMI)-based prognosis of critically patients. Errors in source weight and height data can confound BMI group allocation. The aim of the present work was to examine investigators' reporting on the methods of height and weight acquisition (HWA). ⋯ These findings demonstrate the prevalent risk for BMI group misallocation in the reviewed studies, which may confound BMI-based prognosis, raising concerns about the validity of reported BMI-related prognostic impact.
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Journal of critical care · Oct 2013
ReviewA review of current agents for anticoagulation for the critical care practitioner.
There has been a tremendous boom in the arena of anticoagulant therapy recently. Although the indications for these agents reside in the noncritical care environment, over time, the impact of these agents have infiltrated the critical care environment particularly due to devastating complications with associated use. ⋯ It is important that the critical care practitioner does not ignore these agents but becomes familiar with them to better prepare for the management of patients on one or more anticoagulant agents in the intensive care unit. To equip the critical care practitioners with the knowledge about commonly used anticoagulants, we provide an extensive review of the pharmacology, indications, and adverse effects related to these agents as well as suggestions on preventing or managing complications.