Journal of critical care
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Journal of critical care · Apr 2017
Observational StudyReasons for death in patients with sepsis and septic shock.
Understanding the underlying cause of mortality in sepsis has broad implications for both clinical care and interventional trial design. However, reasons for death in sepsis remain poorly understood. We sought to characterize reasons for in-hospital mortality in a population of patients with sepsis or septic shock. ⋯ In this retrospective cohort, refractory shock and comorbid withdrawal of care were the most common reasons for death. Following prospective validation, the classification methodology presented here may be useful in the design/interpretation of trials in sepsis.
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Journal of critical care · Apr 2017
Can the cerebral regional oxygen saturation be a perfusion parameter in shock?
Shock, defined as a state of tissue hypoperfusion and the tissues reperfusion, is the main goal of management of shock. Increase in central venous saturation (CvSo2) and decrease in blood lactate level are useful in assessment of adequacy of tissue perfusion. Near-infrared spectroscopy is a noninvasive way to observe real-time changes in regional cerebral saturation and has been used in patients with different brain diseases. There is a small body of literature suggesting that cerebral regional oxygen saturation (CrSo2) monitoring added a value in assessment and management of intensive care unit (ICU) patients. ⋯ Cerebral regional oxygen saturation might be helpful as one of the perfusion parameters in patients with shock and it could have a prognostic value in mortality prediction. However, further studies with larger sample size are still needed to validate these results.
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Journal of critical care · Apr 2017
Factors predicting failure of noninvasive ventilation assist for preventing reintubation among medical critically ill patients.
Reintubation after failed extubation is associated with high mortality. Noninvasive ventilation (NIV) has been used to prevent reintubation, but the results have been inconclusive. We investigated the factors predicting failure of NIV-assisted extubation among medical critically ill patients. ⋯ Respiratory failure caused by pneumonia is predictive of failure of NIV-assisted extubation.
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Readmission rate is frequently proposed as a quality indicator because it is related to both patient outcome and organizational efficiency. Currently available studies are not clear about modifiable factors as tools to reduce readmission rate. ⋯ Readmission can be predicted with moderate precision and independent variables associated with readmission are age, severity of disease, type of admission, infection, immunodeficiency and last day noradrenaline use. The latter factor is the only one that can be modified and therefore readmission rate does not meet the criteria to be used as a useful quality indicator.
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Journal of critical care · Apr 2017
Bronchoscopic intubation is an effective airway strategy in critically ill patients.
American Society of Anesthesiologists guidelines recommend the use of bronchoscopic intubation as a rescue technique in critically ill patients. We sought to assess the safety and efficacy of bronchoscopic intubation as an initial approach in critically ill patients. ⋯ Bronchoscopic intubation as an initial strategy in critically ill patients is associated with a higher first-pass success rate than laryngoscopic intubation, and is not associated with an increase in complications.