Journal of critical care
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Journal of critical care · Apr 2014
Epidemiologic features, risk factors, and outcome of sepsis in stroke patients treated on a neurologic intensive care unit.
Because of the immune-suppressive effect of cerebral damage, stroke patients are at high risk for infections. These might result in sepsis, which is the major contributor to intensive care unit (ICU) mortality. Although there are numerous studies on infections in stroke patients, the role of sepsis as a poststroke complication is unknown. ⋯ Sepsis seems to be a frequent complication of stroke patients requiring neurologic ICU treatment. Predictors of sepsis acquisition in our study were comorbidities and severity of deterioration of physiological status, but not stroke severity. A better understanding of risk factors is important for prevention and early recognition, whereas knowledge of outcome may help in prognosis prediction. Further studies are needed to clarify the optimal preventive treatment for these patients.
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Journal of critical care · Apr 2014
Assessment of plasma and red cell trace element concentrations, disease severity, and outcome in patients with critical illness.
The purpose of the study is to examine the value of both plasma and red cell trace element measurements when assessing nutritional status in patients with critical illness. ⋯ The altered plasma concentrations of zinc, selenium, and copper in patients with critical illness were primarily due to the effects of the systemic inflammatory response and do not reliably indicate their status.
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Journal of critical care · Apr 2014
Review Meta Analysis Comparative StudyComparison of the safety and efficacy of propofol with midazolam for sedation of patients with severe traumatic brain injury: A meta-analysis.
To perform a meta-analysis to compare the safety and efficacy of propofol with midazolam for sedation of patients with severe traumatic brain injury. ⋯ Our meta-analysis of 4 studies showed that there are no important differences between propofol and midazolam when administered to provide sedation for patients with severe traumatic brain injury. Further randomized, controlled trials comparing propofol with midazolam for sedation of such patients are needed.
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Journal of critical care · Apr 2014
Observational StudyThe impact of low hemoglobin levels and transfusion on critical care patients with severe ischemic stroke: STroke: RelevAnt Impact of HemoGlobin, Hematocrit and Transfusion (STRAIGHT)-an observational study.
Optimal management of hemoglobin (Hb) and red blood cell transfusion (RBCT) in neurologic intensive care unit (NICU) patients has not been determined yet. Here we aimed to investigate the impact of anemia and transfusion activity in patients who had acute ischemic stroke. ⋯ Low and further decreasing Hb and Hct levels as well as RBCT activity are associated with prolonged NICU stay and duration of MV but not with mortality or long-term outcome. Our findings do not justify using a more aggressive transfusion practice at present.
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Journal of critical care · Apr 2014
ReviewA systematic review of goal directed fluid therapy: Rating of evidence for goals and monitoring methods.
To review the literature on goal directed fluid therapy and evaluate the quality of evidence for each combination of goal and monitoring method. ⋯ This review has highlighted the plethora of goals and methods for monitoring fluid therapy. Strikingly, there is scant high quality evidence, in particular for non-invasive G/M combinations in non-operative and non-intensive care settings. There is an urgent need to address this research gap, which will be helped by methodologies to compare utility of G/M combinations.