Journal of critical care
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Journal of critical care · Aug 2017
Neuromuscular blockade requirement is associated with good neurologic outcome in cardiac arrest survivors treated with targeted temperature management.
We examined the association between neuromuscular blockade (NMB) requirements and outcomes and lactate clearance in cardiac arrest survivors treated with targeted temperature management (TTM). ⋯ Continuous NMB requirement was associated with improved neurologic outcome and decreased in-hospital mortality in cardiac arrest survivors treated with TTM. The NMB requirement was not associated with lactate clearance.
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Journal of critical care · Aug 2017
Observational StudyA prospective study of fungal biomarkers to improve management of invasive fungal diseases in a mixed specialty critical care unit.
The diagnosis of invasive fungal diseases (IFD) in critical care patients (CrCP) is difficult. The study investigated the performance of a set of biomarkers for diagnosis of IFD in a mixed specialty critical care unit (CrCU). ⋯ New diagnostic criteria which incorporate these biomarkers, in particular BDG, and host factors unique to critical care patients should enhance diagnosis of IFD and positively impact antifungal stewardship programs.
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Journal of critical care · Aug 2017
"Pseudo-subarachnoid hemorrhage sign" on early brain computed tomography in out-of-hospital cardiac arrest survivors receiving targeted temperature management.
Newly updated guidelines suggest brain computed tomography for out-of-hospital cardiac arrest survivors to identify a neurologic cardiac arrest cause. We hypothesized that the "pseudo-subarachnoid hemorrhage" (p-SAH) sign in cardiac arrest survivors is associated with poor outcome. ⋯ Pseudo-subarachnoid hemorrhage sign might be one of the simple methods to identify poor neurologic outcome early. However, further prospective studies will be needed to clarify the clinical implication of the p-SAH sign.
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Journal of critical care · Aug 2017
Evaluation of intraventricular colistin utilization: A case series.
Multi-drug resistant organisms (MDROs) are an increasing concern in health systems. Pathogens such as Pseudomonas aeruginosa, Acinetobacter baumanii, and carbapenamase-producing Enterobacteriaceae hold highest mortality rates especially when the central nervous system is involved. When MDROs are cultured treatment options are limited and reliance on medications such as colistin is becoming more prevalent. Penetration of these therapies into the central nervous system is concerning therefore local administration is a potential concomitant therapy. ⋯ The use of intraventricular colistin was associated with positive clinical outcomes with no reported adverse effects.
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Journal of critical care · Aug 2017
Comparative StudyEfficacy and toxicity of high-dose nebulized colistin for critically ill surgical patients with ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii.
Few studies have compared nebulized and intravenous (IV) colistin for multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa pneumonia. This study compared the nephrotoxicity and clinical outcomes for these two delivery routes. ⋯ Nebulized colistin may have less nephrotoxicity and provide similar clinical results, compared to IV colistin.