Journal of critical care
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Journal of critical care · Aug 2016
Randomized Controlled Trial Observational StudyCerebral oximetry as a biomarker of postoperative delirium in cardiac surgery patients.
A promising monitoring strategy for delirium is the use of cerebral oximetry, but its validity during delirium is unknown. We assessed the relationship between oximetry and delirium. We hypothesized that as cerebral oximetry values increased, delirium would resorb. ⋯ This study highlighted the links between increased cerebral oximetry values and delirium resorption. Oximetry values may be useful in monitoring delirium progression, thus assisting in the management of this complicated condition.
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Journal of critical care · Aug 2016
Observational StudyCharacteristics and outcome of patients with the ICU Admission diagnosis of status epilepticus in Australia and New Zealand.
Status epilepticus (SE) is a neurological emergency and may lead to Intensive Care Unit (ICU) admission. However, little is known about the characteristics and outcome of patients with the ICU admission diagnosis of SE. ⋯ Over a 14-year period in ANZ, there have been major changes in the features, management and outcome of patients admitted to ICU with the primary admission diagnosis of SE such that their ICU mortality is now <1%.
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Journal of critical care · Aug 2016
Elevated red cell distribution width at initiation of critical care is associated with mortality in surgical intensive care unit patients.
Recent evidence suggests that red cell distribution width (RDW) is associated with mortality in mixed cohorts of critically ill patients. Our goal was to investigate whether elevated RDW at initiation of critical care in the intensive care unit (ICU) is associated with 90-day mortality in surgical patients. ⋯ Elevated RDW at initiation of care is associated with increased odds of 90-day mortality in surgical ICU patients. These data support the need for prospective studies to determine whether RDW can improve risk stratification in surgical ICU patients.
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Journal of critical care · Aug 2016
Safety of peripheral administration of phenylephrine in a neurologic intensive care unit: A pilot study.
Integral to the management of the neurocritically injured patient are the prevention and treatment of hypotension, maintenance of cerebral perfusion pressure, and occasionally blood pressure augmentation. When adequate volume resuscitation fails to meet perfusion needs, vasopressors are often used to restore end-organ perfusion. This has historically necessitated central venous access given well-documented incidence of extravasation injuries associated with peripheral administration of vasopressors. ⋯ We were able to administer peripheral phenylephrine, up to a dose of 2 μg/(kg min), for an average of 14.29hours (1-54.3) in 20 patients with only 1 possible minor complication and no major complications. This was achieved by adding additional safety measures in our computerized physician order entry system and additional nurse-driven safety protocols. Thus, with careful monitoring and safety precautions, peripheral administration of phenylephrine at an optimized concentration appears to have an acceptable safety profile for use in the neurocritical care unit up to a mean infusion time of 14hours.
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Journal of critical care · Aug 2016
Usefulness of mitral annular plane systolic excursion in assessment of left ventricular systolic function in mechanically ventilated obese patients.
The management of mechanically ventilated patients depends on a combination of clinical skills and measurement of physiological parameters. ⋯ Mitral annular plane systolic excursion is useful, an easier technique, and shorter in duration compared with the eyeball method in the determination of LVSF in mechanically ventilated obese patients.