Journal of critical care
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Journal of critical care · Dec 2016
Plasma syndecan-1 levels identify a cohort of patients with severe sepsis at high risk for intubation after large-volume intravenous fluid resuscitation.
Sepsis damages the endothelial glycocalyx, contributing to fluid extravasation, organ injury, and death. Our goal was to determine if syndecan-1 level is associated with the risk of intubation and modifying effect of intravenous fluids (IVFs) in these patients. ⋯ Syndecan-1 is elevated in emergency department sepsis nonsurvivors. Patients with high syndecan-1 may represent a cohort at particular risk for intubation after large-volume fluid administration.
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Journal of critical care · Dec 2016
Patterns of use of somatosensory-evoked potentials for comatose patients in Canada.
To measure how frequently somatosensory-evoked potentials (SEPs) are used in comatose patients after traumatic brain injury (TBI) and hypoxic ischemic encephalopathy (HIE), how SEPs contribute to outcome prediction and clinical decision making, and how available they are to clinicians. ⋯ There are significant opportunities to optimize the use of SEPs in comatose patients including standardizing SEP testing and reporting, better communicating results to critical care physicians, and improving the understanding regarding the recommended use and interpretation of these tests.
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Journal of critical care · Dec 2016
Measuring intensive care unit performance after sustainable growth rate reform: An example with the National Quality Forum metrics.
Performance measurement is essential for quality improvement and is inevitable in the shift to value-based payment. The National Quality Forum is an important clearinghouse for national performance measures in health care in the United States. ⋯ Crafting performance measures that address core aspects of critical care will be challenging, as current outcome and performance measures have problems with validity. Future quality measures will likely focus on interdisciplinary measures across the continuum of patient care.
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Journal of critical care · Dec 2016
Medication-induced and spontaneous hypoglycemia carry the same risk for hospital mortality in critically ill patients.
Hypoglycemia is associated with increased mortality, but the role of its etiology is unclear. This study aimed to examine the impact of hypoglycemia etiology on mortality risk among critically ill patients. ⋯ Medication-induced hypoglycemia appears to be equally harmful as spontaneous hypoglycemia during critical illness. Future studies should aim to identify strategies to minimize hypoglycemia regardless of etiology, while also minimizing glycemic variability associated with hypoglycemia treatment.
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Journal of critical care · Dec 2016
Prevalence and factors associated with the absence of pharmacologic venous thromboembolism prophylaxis: A cross-sectional study of Georgia intensive care units.
The need for venous thromboembolism prophylaxis is well accepted in the intensive care unit (ICU) and supported by a variety of guideline recommendations. Several studies have highlighted poor adherence to these recommendations, but it is unknown why this discrepancy exists. The aim of this study is assess the prevalence of pharmacoprophylaxis and characterize the practice of withholding prophylaxis. ⋯ Venous thromboembolism prophylaxis is commonly omitted in ICU patients, and reasons for omission vary. An elevated international normalized ratio is associated with withholding of pharmacologic prophylaxis.