Journal of critical care
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Journal of critical care · Jun 2013
Vitamin D and delirium in critically ill patients: a preliminary investigation.
The pathophysiology of delirium in critical illness is unclear. 25-OH vitamin D (25-OHD) has neuroprotective properties but a relationship between serum 25-OHD and delirium has not been examined. We tested the hypothesis that low serum 25-OHD is associated with delirium during critical illness. ⋯ This pilot study suggests that 25-OHD levels measured early during critical illness are not important determinants of delirium risk. Since 25-OHD levels can fluctuate during critical illness, a study of daily serial measurements of 25-OHD levels and their relationship to delirium during the duration of critical illness may yield different results.
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Journal of critical care · Jun 2013
Full Outline of UnResponsiveness score and Glasgow Coma Scale in medical patients with altered sensorium: interrater reliability and relation to outcome.
Full Outline of UnResponsiveness, or FOUR score (FS), is a recently described scoring system for evaluation of altered sensorium. This study examined interrater reliability for FS and Glasgow Coma Scale (GCS) among medical patients with altered mental status and compared outcome predictability of GCS, FS, and Sequential Organ Failure Assessment score. ⋯ Interrater reliability and outcome predictability for FS were comparable with those for GCS. This study supports the use of FS for evaluation of altered mental status in the medical wards.
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Journal of critical care · Jun 2013
Randomized Controlled TrialCardiac output responses in a flow-driven protocol of resuscitation following cardiac surgery.
Determine the role of cardiac output and central venous pressure (CVP) measurements in the clinical decisions that were based on the algorithm used in a randomized trial that compared a colloid to a crystalloid solution in the management of patients early after cardiac surgery (FACS trial, NCT00337805, Crit Care Med 2010; 38:2117). ⋯ Measurement of cardiac output and CVP significantly influenced clinical decisions in the FACS algorithm.
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Journal of critical care · Jun 2013
Improving the 2007 Infectious Disease Society of America/American Thoracic Society severe community-acquired pneumonia criteria to predict intensive care unit admission.
To improve 2007 Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) severity criteria to predict intensive care unit (ICU) admission in patients hospitalized with pneumonia. ⋯ The addition of arterial pH <7.30 to the 2007 IDSA/ATS major criteria improves sensitivity and AUC to identify patients who will require ICU care.
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Journal of critical care · Jun 2013
A structured educational intervention to improve targeted temperature management utilization after cardiac arrest.
Post-arrest targeted temperature management (TTM) has been shown to dramatically improve outcomes after resuscitation, yet studies have revealed inconsistent and slow adoption. Little is known about barriers to TTM implementation and methods to increase adoption. We hypothesized that a structured educational intervention might increase TTM use. ⋯ A focused TTM program led to increased confidence and usage among participants. Future work will focus on targeted training to address specific barriers and increase TTM utilization.