Journal of critical care
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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
Case ReportsHypotensive resuscitation in a head-injured multi-trauma patient.
The concept of permissive hypotension is a controversial topic in trauma care. While driving blood pressure to "normal" levels with large volume crystalloid infusions is not appropriate, definitive data on the target blood pressure for hypotensive resuscitation are lacking. ⋯ The controversies highlighted herein call attention to the role of the intensivist in managing a continuing resuscitation while coordinating the care of other physicians whose therapies can run at cross-purposes to one another. The challenges of the practice of critical care in the 21st century are no more apparent than in the care of a complex trauma patient.
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Journal of critical care · Apr 2014
Observational StudyIncidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing continuous venovenous hemodialysis with regional citrate anticoagulation.
Systemic citrate accumulation is a complication of regional citrate anticoagulation (RCA) during continuous renal replacement therapy (CRRT). Our objective was to determine the incidence of clinical signs consistent with citrate accumulation in a large and representative cohort of intensive care unit patients undergoing RCA-CRRT. ⋯ The incidence of disarrangements consistent with citrate accumulation in patients undergoing RCA-continuous venovenous hemodialysis was low, taking place exclusively in patients with severe lactic acidosis due to multiorgan failure. This suggests that the appearance of citrate accumulation is secondary to a severe failure of cellular respiration.
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Journal of critical care · Apr 2014
Evaluating the obtunded patient after cardiac surgery: The role of continuous electroencephalography.
This prospective study was designed to evaluate the role of continuous electroencephalography (EEG) in the management of adult patients with neurological dysfunction early after cardiac surgery. ⋯ Non-convulsive status epilepticus may be an under-recognized cause of obtundation early after cardiac surgery. Continuous EEG monitoring is a non-invasive test that can identify patients that may benefit from anti-epileptic medication. Larger comparative studies are required to establish whether this leads to significant improvements in patient outcomes.
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Journal of critical care · Apr 2014
The effects of discharge to an intermediate care unit after a critical illness: A 5-year cohort study.
The impact of the intermediate care unit (IMCU) on post-intensive care unit (ICU) outcomes is controversial. ⋯ In a resource-limited setting with a high patient-to-nurse ratio, discharge to IMCU had no impact on 90-day mortality rate and on unplanned readmission rate. The impact of discharge to the IMCU on the outcome for critically ill patients should be evaluated in further studies.