Journal of critical care
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Journal of critical care · Oct 2014
Comparative StudyLimited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes.
The purpose of the study was to compare the effect of limited echocardiography (LE)-guided therapy to standard management on 28-day mortality, intravenous fluid prescription, and inotropic dosing following early resuscitation for shock. ⋯ Limited echocardiography-guided management following early resuscitation is associated with improved survival, less fluid, and increased inotropic prescription. A prospective randomized control trial is required to verify these results.
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Journal of critical care · Oct 2014
An evaluation of the validity and potential utility of facial electromyelogram Responsiveness Index for sedation monitoring in critically ill patients.
The purpose of this study is to explore the validity of a novel sedation monitoring technology based on facial electromyelography (EMG) in sedated critically ill patients. ⋯ Responsiveness Index is not directly comparable with clinical sedation scores but is a potential continuous alert to possible deep sedation in critically ill patients.
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Journal of critical care · Oct 2014
Performance of interleukin-27 as a sepsis diagnostic biomarker in critically ill adults.
We recently identified interleukin-27 (IL-27) as a sepsis diagnostic biomarker in children. Here we assess IL-27 as a sepsis diagnostic biomarker in critically ill adults with systemic inflammatory response syndrome and sepsis. ⋯ IL-27 performed overall poorly in this cohort as a sepsis diagnostic biomarker. Combining IL-27, PCT, and age reasonably estimated the risk of sepsis in subjects with a non-pulmonary source of sepsis. IL-27 may be a more reliable sepsis diagnostic biomarker in children than in adults.
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Journal of critical care · Oct 2014
Drainage of pleural effusion in mechanically ventilated patients: Time to measure chest wall compliance?
Pleural effusion (PE) is commonly encountered in mechanically ventilated, critically ill patients and is generally addressed with evacuation or by fluid displacement using increased airway pressure (P(AW)). However, except when massive or infected, clear evidence is lacking to guide its management. The aim of this study was to investigate the effect of recruitment maneuvers and drainage of unilateral PE on respiratory mechanics, gas exchange, and lung volume. ⋯ Drainage of a moderate-sized effusion should not be routinely performed in unselected population of critically ill patients. We suggest that measurement of C(CW) may help in the decision-making process.
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Journal of critical care · Oct 2014
Observational StudyThe accuracy of Gram stain of respiratory specimens in excluding Staphylococcus aureus in ventilator-associated pneumonia.
To evaluate the Gram stain of deep tracheal aspirate as a tool to direct empiric antibiotic therapy, and more specifically as a tool to exclude the need for empiric antibiotic coverage against Staphylococcus aureus in ventilator-associated pneumonia (VAP). ⋯ Absence of gram-positive bacteria on Gram stain had a high negative predictive value. These data can be used to narrow the initial empiric antibiotic regimen and to avoid unnecessary exposure of patients to vancomycin and other antistaphyloccocal agents.