Journal of critical care
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Journal of critical care · Dec 2014
Case ReportsChlorhexidine gluconate-impregnated central-line dressings and necrosis in complicated skin disorder patients.
Although chlorhexidine gluconate (CHG) disks have been shown to help reduce the incidence of central line-associated blood stream infections, their use can result in local skin necrosis. The effects of CHG disks on patients with complex skin pathology have not been studied. We report 6 cases of dermal necrosis associated with Biopatch (Ethicon Inc, Somerville, NJ) CHG disks in adults with complex skin pathology including those with Stevens-Johnson syndrome, toxic epidermal necrolysis syndrome, graft-versus-host disease, burns, and anasarca. ⋯ Complicated skin disorder patients represent a rare subset of the critically ill who appear prone to CHG disk necrosis. Continuous contact of CHG under occlusive dressings is speculated to predispose Stevens-Johnson syndrome, toxic epidermal necrolysis syndrome, graft-versus-host disease, and burn patients to local chemical injury secondary to loss of the epithelial tissue barrier, decreased cohesion of the epidermal-dermal junction, and increased tissue permeability. In these patients, the risk of placing the CHG disk may present more risk than using alternative antimicrobial dressings.
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Journal of critical care · Dec 2014
Admission high serum sodium is not associated with increased intensive care unit mortality risk in respiratory patients.
Because increased serum osmolarity may be lung protective, we hypothesized that increased mortality associated with increased serum sodium would be ameliorated in critically ill patients with an acute respiratory diagnosis. ⋯ High admission serum sodium is associated with increased odds for ICU death, except in respiratory patients.
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Journal of critical care · Dec 2014
EditorialAnalysis of the reports of high-level commissions that have comprehensively reviewed US public policy on brain death.
The notion of brain death from its inception has not been uniformly understood with many grisly conceptions of it as it pertains to reliability and to organ donation. Accordingly, the aforementioned recitation of statutes and commission reports has served a useful societal role in addressing controversies and misconceptions while promulgating unifying foundational concepts and guidance in practical translation to clinical practice. ⋯ The second is through established procedures to reliably determine the presence of total brain death with the presence of a comatose state which is irreversible. Another common thread through the ethically focused reports has been recognition that organ donation and death are temporally and geographically associated but there is emphasis that the processes of determination of death(by somatic or cerebral criteria) must be logically, ethically, and procedurally separate from the procedures for performing organ harvesting and transplantation.
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Journal of critical care · Dec 2014
Acute kidney injury in critical care: Experience of a conservative strategy.
Renal replacement therapy (RRT) is a major supportive treatment of acute kidney injury (AKI) in intensive care unit (ICU), but the timing of its initiation remains open to debate. ⋯ A conservative approach of AKI was not associated with increased mortality.
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Journal of critical care · Dec 2014
Incidence and long-term outcomes of critically ill adult patients with moderate-to-severe diabetic ketoacidosis: Retrospective matched cohort study.
The objective of this study was to describe the clinical outcomes and treatment intensity of adult intensive care unit (ICU) patients with moderate-to-severe diabetic ketoacidosis (DKA). We aimed also to compare their clinical course with matched non-DKA ICU controls and to identify prognostic factors for mortality and hospital readmission within 1 year. ⋯ Diabetic ketoacidosis necessitating ICU admission is associated with considerable resource utilization and long-term risk for death. Interventions aimed to improve compliance with therapy may prevent readmissions and improve the long-term outcome.