Journal of critical care
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Journal of critical care · Jun 2015
Multicenter Study Observational StudyEvolution and prognosis of long intensive care unit stay patients suffering a deterioration: A multicenter study.
The prognosis of a patient who deteriorates during a prolonged intensive care unit (ICU) stay is difficult to predict. We analyze the prognostic value of the serialized Sequential Organ Failure Assessment (SOFA) score and other variables in the early days after a complication and to build a new predictive score. ⋯ EPIPUSE model can predict mortality with a specificity and positive predictive value of 99% in some groups of patients.
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Journal of critical care · Jun 2015
ReviewIntravenous immunoglobulin in critically ill adults: When and what is the evidence?
Intravenous immunoglobulin (IVIg) use is growing dramatically internationally due to the increasing numbers of acute and chronic conditions that may benefit from IVIg. Patients with conditions that may benefit from IVIg might require intensive care unit (ICU) admission, supporting the need to review IVIg use in the critical care setting. The most common clinical indications for IVIg in adults that may require ICU admission and are commonly supported under clinical practice guidelines are Guillain-Barré syndrome, myasthenia gravis and Lambert-Eaton myasthenic syndrome, inflammatory myopathies, and primary or secondary immunodeficiency diseases complicated by severe bacterial sepsis. ⋯ The evidence for IVIg use in sepsis and septic shock remains controversial and insufficient to recommend its routine use. Intravenous immunoglobulin is expensive and also carries risks of adverse effects, including common and benign infusion-related reactions, as well as relatively rare and more serious problems, such as thromboembolic events, renal failure, and aseptic meningitis. In this article, we review the literature on conditions requiring ICU admission and IVIg, and we classify them as supported, emerging, or unsupported indications based on the available evidence and guidelines for clinical use of IVIg.
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The cadre of information pertinent to critical care medicine continues to expand at a tremendous pace, and we must adapt our strategies of medical education to keep up with the expansion. Differences in learners' characteristics can contribute to a mismatch with historical teaching strategies. Simulation is increasingly popular, but still far from universal. ⋯ Directed strategies of assessment and feedback are often suboptimal. Even strategies of accreditation are evolving. This review attempts to summarize salient concepts, suggest resources, and highlight novel strategies to enhance practice and education in the challenging critical care environment.
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Journal of critical care · Jun 2015
Multicenter Study Observational StudyProcalcitonin-guided therapy may reduce length of antibiotic treatment in intensive care unit patients with secondary peritonitis: A multicenter retrospective study.
Because procalcitonin (PCT) might be surrogate for antimicrobial discontinuation in general intensive care units (ICUs), this study explored its use for secondary peritonitis in 4 surgical ICUs (SICUs). ⋯ Procalcitonin guidance produced 50% reduction in antibiotic duration (P < .001, log-rank test).
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Journal of critical care · Jun 2015
Observational StudyPrehospital tidal volume influences hospital tidal volume: A cohort study.
The purposes of the study are to describe current practice of ventilation in a modern air medical system and to measure the association of ventilation strategy with subsequent ventilator care and acute respiratory distress syndrome (ARDS). ⋯ Low tidal volume ventilation was rare during air medical transport. Air transport ventilation strategy influenced subsequent ventilation but was not associated with ARDS.