Journal of critical care
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Journal of critical care · Jun 2015
Observational StudyFeasibility, safety, and outcome of very early enteral nutrition in critically ill patients: Results of an observational study.
In critically ill patients, early enteral nutrition (EN) within 24 to 72 hours is recommended. Although vasopressor-dependent shock after resuscitation is not a contraindication for EN initiation, feasibility and safety of very early (within 6 hours) EN initiation soon after resuscitation are unknown. ⋯ Initiation of EN within 6 hours of ICU admission is feasible and safe and can be implemented routinely in all ICU patients.
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Journal of critical care · Jun 2015
Observational StudyIntravenous immunoglobulin improves sepsis-induced coagulopathy: A retrospective, single-center observational study.
Inflammation and coagulation are closely interrelated processes in the pathogenesis of sepsis. This study aimed to determine whether intravenous immunoglobulin (IVIg) could improve the hyperinflammatory state and coagulation/fibrinolysis abnormalities in patients with sepsis. ⋯ Intravenous immunoglobulin treatment significantly improved hemostatic abnormalities along with the hyperinflammatory state in patients with sepsis. Accordingly, IVIg treatment should be classified as an adjunctive therapy for patients complicated with sepsis-induced coagulopathy.
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Journal of critical care · Jun 2015
Observational StudyAcute kidney injury in a Malaysian intensive care unit: Assessment of incidence, risk factors, and outcome.
Acute kidney injury (AKI) is common and carries a high mortality rate. Most epidemiological studies were retrospective and were done in Western populations. We aim to assess its incidence using both urine output and creatinine criteria and its association with risk factors and outcome. ⋯ Acute kidney injury is common in our ICU, and almost half are of highest severity stage. Patients with high severity of illness and septic shock were at risk for AKI. The presence of AKI independently predicted mortality.
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Journal of critical care · Jun 2015
Clinical outcomes associated with high, intermediate, and low rates of failed extubation in an intensive care unit.
Extubation failure is associated with adverse outcomes in mechanically ventilated patients, and it is believed that high rates of failed planned extubation (FPE) should be avoided. However, many believe that very low rates may also correlate with adverse outcomes if resulting from overly conservative weaning practices. We examined the relationship between the percentage of FPE (%FPE) and associated outcomes, with the aim of elucidating a favorable middle range. ⋯ Although exact rates may vary depending on setting, this suggests that a high %FPE (>15) should be avoided in the intensive care unit and that there may be an intermediate range where ventilator outcomes are optimized.
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Journal of critical care · Jun 2015
Advanced imaging use in intensive care units has decreased, resulting in lower charges without negative effects on patient outcomes.
There has been both greater recognition and scrutiny of the increased use of advanced imaging. Our aim was to determine whether there has been a change over time in the use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US) modalities in the intensive care units (ICUs). ⋯ Advanced imaging use decreased for 5 years in the ICUs, resulting in decreased charges without negative effects on patient outcomes.