Journal of critical care
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Altered mental status is a common pathological entity in critically ill patients and particularly in those with preexisting cerebral injury. In the neurological critical care unit, the prevalence of altered mental status is especially high because of the inherent nervous system disease of these patients. ⋯ Although often used interchangeably, the 2 pathological entities have subtle differences in etiology and presentation. This is a review of delirium and encephalopathy in the neurological critical care unit.
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Journal of critical care · Dec 2015
Observational StudyAssessment of muscle tissue oxygen saturation after out-of-hospital cardiac arrest.
Pathophysiology of cardiac arrest corresponds to an ischemia-reperfusion syndrome with deep impairment of microcirculation. Muscular tissue oxygen saturation (StO2) is a noninvasive method of evaluation of microcirculation. Our study was aimed at assessing the prognosis value of muscular StO2 in patients admitted for out-of-hospital cardiac arrest (OHCA) and treated with hypothermia. ⋯ After an OHCA treated with therapeutic hypothermia, StO2 was correlated with outcome. Further research is needed to better understand the pathophysiological process underlying our results.
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Journal of critical care · Dec 2015
ReviewPANCREATITIS OR NOT? - Elevated lipase and amylase in ICU patients.
Elevation in serum levels of pancreatic enzymes (Hyperamylasemia and/or Hyperlipasemia) can occur in any Intensive Care Unit (ICU) patient either as a result of true acute pancreatitis (AP) or as a reflection of a non-pancreatic disease. Although most patients may not have clinical pancreatitis, identifying true acute pancreatitis in the ICU setting may be critical in the presence of associated co-morbid conditions of the disease for which the patient is being managed. With neither amylase nor lipase being specific for pancreatitis, it is important for the clinician to be aware of different causes of hyperamylasemia and hyperlipasemia, especially when clinical diagnosis of pancreatitis is unclear. This review will focus on understanding different non-pancreatic conditions where there is elevation of pancreatitis enzymes and to identify true acute pancreatitis in critically ill patients without typical symptoms.
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Journal of critical care · Dec 2015
Feasibility and safety of in-bed cycling for physical rehabilitation in the intensive care unit.
The purpose was to evaluate the feasibility and safety of in-bed cycle ergometry as part of routine intensive care unit (ICU) physical therapist (PT) practice. ⋯ Use of in-bed cycling as part of routine PT interventions in ICU patients is feasible and appears safe. Further study of the potential benefits of early in-bed cycling is needed.
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Journal of critical care · Dec 2015
Impact of late fluid balance on clinical outcomes in the critically ill surgical and trauma population.
Management of fluid status in critically ill patients poses a significant challenge due to limited literature. This study aimed to determine the impact of late fluid balance management after initial adequate fluid resuscitation on in-hospital mortality for critically ill surgical and trauma patients. ⋯ Consistent with previous literature, high fluid balance on postoperative day 7 was associated with increased in-hospital mortality. Patients who received and responded to diuretic therapy did not demonstrate improved clinical outcomes, which questions their use in the postoperative period.