Journal of critical care
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Journal of critical care · Oct 2014
ReviewCritically ill cancer patient in intensive care unit: Issues that arise.
Advances in the management of malignancies and organ failures have led to substantial increases in survival as well as in the number of cancer patients requiring intensive care unit (ICU) admission. Although effectiveness of ICU in this group remains controversial, the heterogeneity of its population in terms of the nature and curability of their disease and the severity of critical illness and underlying conditions may explain the plethora of issues arising when considering cancer patients for ICU admission, especially from the view of limited resources and ICU beds. The most frequent reasons leading a cancer patient to ICU are postoperative, respiratory failure, infection, and sepsis. ⋯ A multidisciplinary treating team of physicians should aid in changing the goals from restorative to palliative care when there appears to be no possible benefit from any treatment. End-of life-decisions and code status should be made by consensus, based on patients' autonomy and dignity. Further interventional multicenter studies are required to assess post-ICU burden, long-term medical outcomes, and quality of life in this cohort of patients.
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Journal of critical care · Oct 2014
Multicenter StudyMarkers of poor outcome in patients with acute hypoxemic respiratory failure.
This study described the acute hypoxemic respiratory failure (AHRF) population and identified potential modifiable markers of outcome. ⋯ Lower baseline oxygenation (Pao2/Fio2) is a poor prognostic marker in acute hypoxemic respiratory failure.
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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
Frequency of acute changes found on head computed tomographies in critically ill patients: A retrospective cohort study.
The frequency of positive findings on computed tomography (CT) of the head in critically ill patients who develop neurologic dysfunction is not known. ⋯ Acute changes on head CTs performed for concern regarding new focal neurologic deficit or seizures are frequent compared with those performed for AMS with a nonfocal examination. No specific patient characteristics or medications were associated with a large change in the likelihood of finding an acute change for patients with AMS.