Journal of critical care
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Journal of critical care · Apr 2015
Classification of daily mental status in critically ill patients for research purposes.
The purpose of this study is to develop a reliable tool for daily mental status classification in intensive care unit (ICU) patients for research purposes. Secondly, to identify patients with single, 1-day episodes of delirium and to compare them with patients having more delirium days or episodes. ⋯ The algorithm for daily mental status classification seems to be a valid tool. In a substantial proportion of patients, delirium occurs only once during ICU admission lasting only 1 day.
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Journal of critical care · Apr 2015
Incidence and risk factor evaluation of exposure keratopathy in critically ill patients: A cohort study.
Recent emphasis on eye care in intensive care unit (ICU) patients has translated to eye assessment being part of routine care. In this setting, we determined the incidence, risk factors, and resolution time of exposure keratopathy. ⋯ Severe exposure keratopathy is infrequent in a protocolized ICU setting. Eyelid position and duration of ventilation are associated with exposure keratopathy.
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Journal of critical care · Apr 2015
Unfractionated heparin dosing for therapeutic anticoagulation in critically ill obese adults.
Research evaluating unfractionated heparin (UFH) dosing in obese critically ill populations is limited. This study aimed to determine optimal weight-based and total therapeutic infusion rates of UFH in this population. ⋯ Patients greater than or equal to 130 kg have lower weight-based heparin requirements compared with patients 95 to 104 kg. This difference appears to be driven by patients greater than 165 kg. Patients greater than 165 kg have lower weight-based heparin requirements, whereas patients from 105 to 164 kg have weight-based requirements similar to a normal-weight patient population. Initiating heparin at appropriate weight-based doses for obese patients may optimize anticoagulation.
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Journal of critical care · Apr 2015
Candidemia-induced pediatric sepsis and its association with free radicals, nitric oxide, and cytokine level in host.
Candida species has become the seventh most frequent causal microorganisms of nosocomial sepsis. Prematurity and low birth weights are strongly associated with the development of neonatal nosocomial bloodstream infections. Candida albicans has been the species most often associated with neonatal infections, but recently, there has been a changing pattern in the isolates recovered from neonates with invasive candidiasis, which poses resistance to the existing class of azoles such as fluconazole antifungals along with cross resistance to newer triazoles, which results in a therapeutic challenge in invasive fungal infections causing high incidence of mortality. ⋯ Furthermore, the change in free radical, cytokine release, and nitric oxide synthase expression and nitric oxide release from polymorphonuclear leukocytes isolated from control and pediatric sepsis cases were also performed. The present study probably for the first time reports the change in increasing incidence of nonalbicans Candida-induced sepsis in neonates and children admitted to the intensive care unit of hospital, and current antibiotics load posing resistance for antifungal treatment strategy and provide serious threats in future treatment. The increase in free radicals in polymorphonuclear leukocytes and increase in expression of nitric oxide synthase expression and nitric oxide release in Candida-infected pediatric sepsis cases underlie the role of host factor in dissemination and invasiveness of infection from exogenous sources and pathogenesis of systemic inflammation during sepsis.
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Journal of critical care · Apr 2015
Medical intensive care unit consults occurring within 48 hours of admission: A prospective study.
Critical care consults requested shortly after admission could represent a triage error. This consult process has not been adequately assessed, and data are retrospective relying on discharge diagnoses. ⋯ Prospective examination of the consult process suggests that disease progression rather than triage error accounted for most unplanned transfers. Functional status and comorbidity predicted MICU admission rather than illness severity. Goals of care were not being discussed adequately. We did not detect differences in mortality although hospital length of stay was increased.