Journal of critical care
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Journal of critical care · Feb 2018
Observational StudyCirculating syndecan-1 predicts the development of disseminated intravascular coagulation in patients with sepsis.
One of the pathophysiological processes in sepsis is endothelial dysfunction, which leads to disseminated intravascular coagulation (DIC). Syndecan-1 is a major structural component of the endothelium and plays a key role in endothelial function. The purpose of this study was to assess the value of syndecan-1 as a predictive marker for DIC in sepsis. ⋯ Syndecan-1 levels were associated with not only the severity of illness and mortality but also DIC development in sepsis, suggesting that syndecan-1 could be a predictive marker of DIC.
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Journal of critical care · Feb 2018
ReviewOvercoming the Warburg Effect: Is it the key to survival in sepsis?
Sepsis is a leading cause of mortality in the U. S. and Europe. Sepsis and septic shock are the results of severe metabolic abnormalities following infection. ⋯ Although the initial pathways of cancer and sepsis may be different, the mechanisms which allow aerobic glycolysis to occur, even in the presence of oxygen, are similar. This review provides some evidence that reversing these steps reverses the Warburg Effect in model systems and some pathological consequences of this effect. Therefore, this implies that these steps might be modifiable in sepsis to reverse the Warburg Effect and possibly lead to better outcomes.
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Journal of critical care · Feb 2018
Multicenter StudyPhysician attire in the intensive care unit in Japan influences visitors' perception of care.
The objective of this study is to evaluate the impact of physician attire and behavior on perceptions of care by ICU visitors in Japan. ⋯ Physician attire in the ICU affects perceptions of care. Implementation of attire guidelines which require clothing that does not meet visitor preferences should be accompanied by education programs.
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Journal of critical care · Feb 2018
Multicenter StudyEnd-of-life discussions: Who's doing the talking?
To determine, in a tertiary academic medical center, the reported frequency of end-of-life discussions among nurses and the influence of demographic factors on these discussions. ⋯ In a survey conducted in two tertiary care institutions, more than one-third of nurses from all disciplines responded that they never or almost never discuss end-of-life issues with their patients. Specialty influenced the likelihood of discussing end-of-life issues with patients.
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Journal of critical care · Feb 2018
qSOFA score: Predictive validity in Enterobacteriaceae bloodstream infections.
To determine whether the quick Sequential Organ Failure Assessment (qSOFA) retains predictive validity in patients with Enterobacteriaceae sepsis that all received appropriate initial antimicrobial therapy. ⋯ Our results support qSOFA score, AMS, and sepsis severity as acceptable bedside tools for prognostication during initial clinical assessment in patients with sepsis. qSOFA retained its predictive validity in this cohort, suggesting that appropriate initial antimicrobial therapy is not an effect modifier for mortality when using qSOFA for prognostication.