Journal of critical care
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Journal of critical care · Feb 2017
Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock.
Lactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >4mmol/L, we compared mortality prediction between a subsequent lactate ≥4mmol/L to a <10% and <20% decrease between initial and subsequent lactate values. ⋯ A subsequent lactate ≥4mmol/L and lactate reduction <20% were associated with increased in-hospital mortality, whereas a lactate reduction <10% was not. Sensitivity and specificity are different between these parameters.
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Journal of critical care · Feb 2017
Comparative StudyMeasurement of pleural pressure swings with a fluid-filled esophageal catheter vs pulmonary artery occlusion pressure.
Pleural pressure measured with esophageal balloon catheters (Peso) can guide ventilator management and help with the interpretation of hemodynamic measurements, but these catheters are not readily available or easy to use. We tested the utility of an inexpensive, fluid-filled esophageal catheter (Peso) by comparing respiratory-induced changes in pulmonary artery occlusion (Ppao), central venous (CVP), and Peso pressures. ⋯ A fluid-filled esophageal catheter provides a high-quality, easily accessible, and inexpensive measure of change in pleural pressure and provided insights into patient-ventilator interactions.
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Journal of critical care · Feb 2017
Observational StudyEvaluation of sedatives, analgesics, and neuromuscular blocking agents in adults receiving extracorporeal membrane oxygenation.
The objective of this study was to evaluate the use of sedative, analgesic, and neuromuscular blocking agents (NMBAs) in patients undergoing extracorporeal membrane oxygenation (ECMO) support. ⋯ Patients received relatively low doses of sedatives and analgesics while at a light level of sedation on average. Patients rarely required neuromuscular blockade.
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Journal of critical care · Feb 2017
Statistical models for fever forecasting based on advanced body temperature monitoring.
Body temperature monitoring provides health carers with key clinical information about the physiological status of patients. Temperature readings are taken periodically to detect febrile episodes and consequently implement the appropriate medical countermeasures. However, fever is often difficult to assess at early stages, or remains undetected until the next reading, probably a few hours later. ⋯ Both of them exhibited a fever peak forecasting accuracy greater than 84%. When compared with experts' assessment, both models identified 35 (97.2%) of 36 fever spikes. The models proposed are highly accurate in forecasting the appearance of fever spikes within a short period in patients with suspected or confirmed febrile-related illnesses.
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Journal of critical care · Feb 2017
Valproate for agitation in critically ill patients: A retrospective study.
The purpose was to describe the use of valproate therapy for agitation in critically ill patients, examine its safety, and describe its relationship with agitation and delirium. ⋯ Valproate therapy was associated with a reduction in agitation, delirium, and concomitant psychoactive medication use within 48 hours of initiation.