Journal of critical care
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Journal of critical care · Jun 2017
Acute kidney injury is an independent risk factor for myocardial injury after noncardiac surgery in critical patients.
Myocardial injury after noncardiac surgery (MINS) contributes to mortality and morbidity. However, risk factors accelerating its development remain unclear. The aim of this study was to identify the incidence and risk factors of MINS. ⋯ The incidence of MINS in critical patients is high. Postoperative AKI is an independent risk factor of MINS in critical patients. It is recommended that postoperative kidney functions be routinely assessed in all critical patients after noncardiac surgery.
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Journal of critical care · Jun 2017
Brain death after decompressive craniectomy: Incidence and pathophysiological mechanisms.
Patients who received decompressive craniectomy (DC) are usually not regarded to qualify for brain death (BD) as intracranial pressure (ICP) is not assumed to reach levels critical enough to cause cerebral perfusion failure. Here we investigated the incidence of BD after DC and analyzed the pathophysiological mechanisms. ⋯ Our study evidences that DC does not exclude BD. Even after DC, BD is preceded by a severely reduced CPP, supporting loss of cerebral perfusion as a critical step in BD pathophysiology.
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Journal of critical care · Jun 2017
Fluid overload and outcomes in critically ill children: A single center prospective cohort study.
To prospectively evaluate the association between fluid overload (FO) and clinical outcomes, mortality, mechanical ventilation (MV), and duration and length of stay in a pediatric intensive care unit (PICU). ⋯ FO is frequent in a general PICU population, but PFO is not an independent risk factor for mortality. Future studies of FO should focus on patients with AKI and multiorgan failure for better classification of severity and potential interventions.
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Journal of critical care · Jun 2017
No difference in mechanical ventilation-free hours in critically ill patients who received intravenous, oral, or enteral phosphate replacement.
To determine the impact on duration of mechanical ventilation (MV) and the need for reintubation after changing from intravenous (IV) to oral phosphate formulations, in response to a national shortage of IV phosphate. ⋯ No difference in MV-free hours or need for reintubation was observed after a national shortage requiring the restriction of IV phosphate supplementation. Oral phosphate replacement is a safe and an efficient alternative.
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Journal of critical care · Jun 2017
Interhospital transfers of the critically ill: Time spent at referring institutions influences survival.
To determine if the length of stay at a referring institution intensive care unit (ICU) before transfer to a tertiary/quaternary care facility is a risk factor for mortality. ⋯ Length of stay at the referring institution before transfer is a risk factor for worse outcomes, with longer stays associated with increased likelihood of mortality. Further studies delineating which factors most affect length of stay at referring institutions, though a difficult task, should be pursued.