Journal of critical care
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Journal of critical care · Jun 2015
Long-term survival of adults with cardiogenic shock after venoarterial extracorporeal membrane oxygenation.
This study was designed to examine the long-term survival of patients who survived to be weaned from venoarterial extracorporeal membrane oxygenation (VA ECMO) and to determine which factors present at initiation and during ECMO predict long-term survival. We further sought to develop the preliminary long-term outcome after VA ECMO score that would predict patient outcome and to assess its accuracy at various time points. ⋯ Good long-term survival can be achieved in patients who have been successfully weaned from VA-ECMO. The factors present at initiation and during ECMO can relate to altered risk of long-term survival.
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Journal of critical care · Jun 2015
Symptom burden and health-related quality of life among intensive care unit survivors in Argentina: A prospective cohort study.
Our goal was to describe the evolution of selected physical and psychologic symptoms and identify the determinants of health-related quality of life (HRQOL) after intensive care unit (ICU) discharge. ⋯ Determinants of HRQOL after ICU discharge were both related to late sequelae of critical illness and to some events occurring in the ICU. Notwithstanding the high symptom burden, patients still perceived their HRQOL as good.
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The human body is a tightly controlled engineering miracle. However, medical training generally does not cover "control" (in the engineering sense) in physiology, pathophysiology, and therapeutics. A better understanding of how evolved controls maintain normal homeostasis is critical for understanding the failure mode of controlled systems, that is, disease. ⋯ Control systems are ubiquitous in physiology, although often unrecognized. Here we provide selected examples of the role of control in physiology (heart rate variability, immunity), pathophysiology (inflammation in sepsis), and therapeutic devices (diabetes and the artificial pancreas). We also present a high-level background to the concept of robustly controlled systems and examples of clinical insights using the controls framework.
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Journal of critical care · Jun 2015
Increased incidence of diuretic use in critically ill obese patients.
Sodium retention occurs commonly in cardiac and liver disease, requiring the administration of diuretics to restore fluid balance. Whether obesity is associated with sodium retention has not been fully evaluated. ⋯ Critically ill obese patients are more likely to receive diuretics during their stay in the ICU and to receive higher dosages of diuretics. Our data suggest that obesity is an independent risk factor for sodium retention.
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Journal of critical care · Jun 2015
Comparative StudySave the patient a trip. Outcome difference between conservatively treated patients with traumatic brain injury in a nonspecialized intensive care unit vs a specialized neurosurgical intensive care unit in the Sultanate of Oman.
Traumatic brain injury (TBI) continues to be the main cause of death among trauma patients. Accurate diagnosis and timely surgical interventions are critical steps in reducing the mortality from this disease. For patients who have no surgically reversible head injury pathology, the decision to transfer to a dedicated neurosurgical unit is usually controversial. ⋯ There is no difference in outcome between patients with TBI treated conservatively in a specialized neurosurgical ICU and those treated in a general nonspecialized ICU in Oman in 2013. Therefore, unless neurosurgical intervention is warranted or expected, patients with TBI may be managed in a general ICU, saving the risk and expense of a transfer to a specialized neurosurgical ICU.