Journal of critical care
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Journal of critical care · Apr 2018
Multicenter StudyUtility of electronic AKI alerts in intensive care: A national multicentre cohort study.
Electronic AKI alerts highlight changes in serum creatinine compared to the patient's own baseline. Our aim was to identify all AKI alerts and describe the relationship between electronic AKI alerts and outcome for AKI treated in the Intensive Care Unit (ICU) in a national multicentre cohort. ⋯ The study provides a nationwide characterisation of AKI in ICU highlighting the high incidence and its impact on patient outcome. The data also suggests that within the cohort of AKI patients treated in the ICU there are significant differences in the presentation and outcome between those patients that require transfer to the ICU after AKI is identified and those who develop AKI following ICU admission. Moreover, the study demonstrates that using AKI e-alerts provides a centralised resource which does not rely on clinical diagnosis of AKI or coding, resulting in a robust data set which can be used to define the incidence and outcome of AKI in the ICU setting.
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Journal of critical care · Apr 2018
The predictive performances of equations used to estimate unbound phenytoin concentrations in a medical ICU population and the impact of exogenous albumin administration.
This study evaluated the predictive performances of four equations (Sheiner-Tozer [ST], Kane-modified ST, Anderson-modified ST, and Cheng-modified ST) used to estimate free phenytoin concentrations in a medical intensive care unit (MICU) and assessed the impact of exogenously administered albumin. ⋯ Estimating unbound concentrations with equations in the MICU population is discouraged.
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Journal of critical care · Apr 2018
Multicenter StudyMeasurement of respiratory rate by multiple raters in a clinical setting is unreliable: A cross-sectional simulation study.
To evaluate the inter-observer reliability of nurses assessing respiratory rate. ⋯ We found a wide variation in measurements of RR with both few and many observers assessing exactly the same patients.
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Journal of critical care · Apr 2018
ICU team composition and its association with ABCDE implementation in a quality collaborative.
Awakening, Breathing Coordination, Delirium, and Early Mobility bundle (ABCDE) should involve an interprofessional team, yet no studies describe what team composition supports implementation. ⋯ ABCDE implementation was associated with frequent involvement of team members, suggesting a need for role articulation and coordination.
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Journal of critical care · Apr 2018
Anti-aging factor, serum alpha-Klotho, as a marker of acute physiological stress, and a predictor of ICU mortality, in patients with septic shock.
Genetic deletions decreasing serum alpha-Klotho (alpha-KL) have been associated with rapid aging, multi-organ failure and increased mortality in experimental sepsis. We hypothesized that lower alpha-KL obtained at the onset of septic shock correlates with higher mortality. ⋯ Elevated serum alpha-KL in patients with septic shock is independently associated with higher mortality. Further studies are needed to corroborate these findings.