Journal of critical care
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Journal of critical care · Apr 2018
Observational StudyNeuromuscular electrophysiological disorders and muscle atrophy in mechanically-ventilated traumatic brain injury patients: New insights from a prospective observational study.
It is unclear whether the muscular changes in mechanically-ventilated traumatic brain injury patients (TBI) are only associated with disuse or additionally to neuromuscular electrophysiological disorders (NED). The correlation between muscle atrophy and NED may affect functional outcomes and rehabilitation programs significantly. ⋯ Mechanically-ventilated patients with TBI developed NED in addition to changes in muscle structure during their stay in the ICU.
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Journal of critical care · Apr 2018
Multicenter StudyAssociation of high mortality with extended-spectrum β-lactamase (ESBL) positive cultures in community acquired infections.
Infections due to multidrug resistant organisms have become a serious health concern worldwide. The present study was conducted to investigate the spectrum of microbial resistance pattern in the community and their effects on mortality. ⋯ Out of 5309 patients enrolled; 3822 had suspected clinical infection on admission with 1452 patients growing positive microbial cultures. Among these, 201 bacterial strains were isolated from patients who had community acquired infections. 73% were Gram negative bacilli, commonest being E. coli (63%). 63.4% E. coli and 60.7% Klebsiella isolates were ESBL producers. The mortality in ESBL positive infections was significantly higher as compared to ESBL negative infections (Odds ratio 2.756). Moreover, ESBL positive patients empirically treated with Beta Lactams+Beta Lactamase inhibitors (BL+BLI) had significantly higher mortality as compared to patients treated with carbapenems. More data from multiple centres need to be gathered to formulate appropriate antibiotic policy for critically ill patients admitted from the community.
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Journal of critical care · Apr 2018
Predictors of hemodynamic derangement during intubation in the critically ill: A nested case-control study of hemodynamic management-Part II.
Our primary aim was to identify predictors of immediate hemodynamic decompensation during the peri-intubation period. ⋯ Hemodynamic derangement occurred at a rate of 40% and was associated with increased mortality. Increasing age, use of non-invasive ventilation before intubation, and increased pre-intubation shock and modified shock index values were significantly associated with hemodynamic derangement post-intubation.
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Journal of critical care · Apr 2018
Noninvasive ventilation failure in pneumonia patients ≥65years old: The role of cough strength.
To explore the association between cough strength and outcomes in elderly patients who received noninvasive ventilation (NIV) due to acute respiratory failure caused by pneumonia. ⋯ In pneumonia patients ≥65years old, no/weak cough is associated with NIV failure and death in hospital. NIV must be used only with caution in no/weak cough patients.
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Journal of critical care · Apr 2018
Observational StudyThe effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study.
The study purpose was to define changes in coagulation across the sepsis spectrum using rotational thromboelastometry (ROTEM). ⋯ ROTEM indicated significantly enhanced clot structural development in sepsis and severe sepsis, which could be indicative of a hypercoagulable phase. In septic shock, despite there being a prolongation of clotting pathways and impaired fibrinolysis, clot mass was comparably normal, suggestive of the development of a clot with healthy characteristics.