Journal of critical care
-
Journal of critical care · Jun 2017
Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
Using administrative codes and minimal physiologic and laboratory data, we sought a high-specificity identification strategy for patients whose sepsis initially appeared during their ICU stay. ⋯ Selected administrative codes coupled to SIRS criteria and applied to patients admitted to ICU can yield up to 94% authentic sepsis patients. However, only 1/3 of patients thus identified appeared to become septic during their ICU stay. Studies that depend on high-intensity monitoring for description of the time course of sepsis require clinician review and verification that sepsis initially appeared during the monitoring period.
-
Journal of critical care · Jun 2017
Observational StudyCarotid systolic flow time with passive leg raise correlates with fluid status changes in patients undergoing dialysis.
Corrected carotid systolic flow time (CFTc) has been proposed as a measure of volume status in acutely ill patients. This study endeavors to determine whether the change in CFTc with passive leg raise (PLR) maneuver correlates with volume status changes. Dialysis patients at Kingston General Hospital (Kingston, Canada) underwent point-of-care carotid ultrasonography at the beginning and the end of dialysis. ⋯ Particularly, in our sample of patients, a 30milliseconds increase in CFTc with PLR predicted the post-dialysis volume state (LR+=11) whereas an increase of less than 20milliseconds argued against it (LR-=0.079). The assessment of CFTc pre- and post-PLR correlates with intravascular volume changes in patients undergoing dialysis. Alternative to the currently available bedside modalities, this technique is non-invasive, objective, simple to perform at the bedside, and reversible with respect to volume challenge.
-
Journal of critical care · Jun 2017
Observational StudyStress echocardiography in patients who experienced mechanical ventilation weaning failure.
Critically ill patients may suffer varying degrees of temporary myocardial dysfunction during respiratory weaning that could play an important role in weaning failure. ⋯ Stress echocardiography may be helpful in detecting silent diastolic and systolic dysfunction or severe MR that could have a major impact on respiratory weaning.
-
Journal of critical care · Jun 2017
Early continuous renal replacement therapy in septic acute kidney injury could be defined by its initiation within 24 hours of vasopressor infusion.
The optimal timing for the initiation of early continuous renal replacement therapy (CRRT) is uncertain and requires a practically feasible definition with acceptable evidence. ⋯ Considering the possible therapeutic measurement by physician on the basis of the results in this study, early CRRT could be defined by a Tvaso-CRRT less than 24 h.
-
Journal of critical care · Jun 2017
Observational StudyContinuous electroencephalography in a mixed non-neurological intensive care population, an observational study.
Continuous electroencephalography (cEEG) improves monitoring of the brain in unconscious patients, but implementation at ICU is difficult. The present investigation shows a way to introduce cEEG at an anesthesiological ICU and discusses the first experiences. ⋯ Continuous electroencephalography recording is feasible and manageable. Automatic seizure detection was often false negative/positive; therefore, the interpretation of the cEEG should be supported by EEG-trained neurologists. Background EEG activity was not associated with outcome parameters, which suggests that background activity is a poor outcome predictor.