Journal of critical care
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Journal of critical care · Feb 2018
Elevated modified shock index in early sepsis is associated with myocardial dysfunction and mortality.
The aim of this study was to explore the association of an elevated modified shock index (MSI) in sepsis and myocardial dysfunction. ⋯ Elevated modified shock index during early sepsis is associated with the development of myocardial dysfunction and depression, SOFA score and mortality.
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Journal of critical care · Feb 2018
Delirium characteristics and outcomes in medical and surgical lnpatients: A subgroup analysis.
Persistent delirium can negatively affect patients, increase healthcare costs, and extend the length of hospital stays. This investigation was undertaken to explore associations between patient characteristics and delirium outcomes. ⋯ The findings that patient type and timing of postoperative delirium are associated with differential delirium outcomes suggest that targeted screening and intervention approaches may be needed. Medical patients were more likely to be discharged before recovery from delirium compared with surgical patients. Differences in underlying chronic medical conditions may account for the observed differences in discharge condition between medical and surgical patients with delirium.
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Journal of critical care · Feb 2018
Critical Care and Personalized or Precision Medicine: Who needs whom?
The current paradigm of modern healthcare is a reactive response to patient symptoms, subsequent diagnosis and corresponding treatment of the specific disease(s). This approach is predicated on methodologies first espoused by the Cnidean School of Medicine approximately 2500years ago. More recently escalating healthcare costs and relatively poor disease treatment outcomes have fermented a rethink in how we carry out medical practices. ⋯ Practitioners of CCM have been participating in Personalized Medicine unknowingly as it takes the protocols of sepsis, mechanical ventilation, and daily awakening trials and applies it to each individual patient. However, the immediate next step for CCM should be an active development of Precision Medicine. This developmental process should break down the silos of modern medicine and create a multidisciplinary approach between clinicians and basic/translational scientists.
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Journal of critical care · Feb 2018
Timing of venous thromboembolism chemoprophylaxis after traumatic brain injury.
Currently no national standard exists on optimal timing to initiate VTE chemoprophylaxis after traumatic brain injury (TBI). We designed this survey to assess current practice regarding the timing of VTE chemoprophylaxis after TBI. ⋯ Currently there is a wide variability in the practice patterns regarding the timing of VTE chemoprophylaxis in TBI patients. This survey reinforces the need for further investigation to guide clinical practice.
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Journal of critical care · Feb 2018
The effect of early renal replacement therapy guided by plasma neutrophil gelatinase associated lipocalin on outcome of acute kidney injury: A feasibility study.
The optimal time and the parameter utilized for decision to initiate renal replacement therapy (RRT) in acute kidney injury (AKI) are still controversial. Recently, high levels of plasma NGAL (pNGAL) has been strongly correlated with poor AKI outcome. This is a feasibility study conducted to test whether early RRT initiation guided by pNGAL could improve AKI outcome. ⋯ Our finding suggested that it was feasible to use pNGAL to triage severe AKI patients. However, early initiation of RRT in this high risk group did not affect the 28-day mortality.