Journal of critical care
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Journal of critical care · Oct 2019
High-sensitivity troponin T is an important independent predictor in addition to the Simplified Acute Physiology Score for short-term ICU mortality, particularly in patients with sepsis.
Elevated cardiac troponin levels have been shown to be associated with a poor prognosis under some intensive care conditions. This study investigated whether inclusion of high-sensitivity troponin T (hsTnT) increased the prognostic accuracy of the Simplified Acute Physiology Score (SAPS 3) for general intensive care unit (ICU) patients, cardiac arrest patients, or patients with a non-cardiac arrest diagnosis. ⋯ Addition of hsTnT evaluation to SAPS 3 enhances the predictive capability of this model in relation to mortality. In sepsis, the hsTnT level may be an important prognostic marker.
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Journal of critical care · Oct 2019
The paradox prevails: Outcomes are better in critically ill obese patients regardless of the comorbidity burden.
During critical illness, obese patients have better outcomes compared to patients with normal BMI, and this is known as the obesity paradox. The difference in comorbidity burden have been implied to be responsible for the paradox. We performed a retrospective review from 2001 to 2012 of critically ill patients from the Medical Information Mart for Intensive Care database. ⋯ The odds of inpatient mortality were lower in obese patients compared to patients with normal BMI; in group with the least comorbidity score (Elixhauser <0) [OR: 0.47, CI (0.28-0.80), p-value 0.006] and higher comorbidity scores, (Elixhauser 1-5) [(OR: 0.66, CI (0.46-0.95), p-value 0.02)] and (Elixhauser 6-13) [OR: 0.69, CI (0.53-0.92), p-value 0.01]. 30-day mortality was also significantly lower in obese patients, in groups with the lowest (Elixhauser <0) [OR:49, CI (0.31-0.77), p-value 0.002] as well as the highest comorbidity burden (Elixhauser >14) [OR:0.59, CI (0.45-0.77), p-value <.001]. Subgroup analysis in patients with various comorbidities showed better outcomes in obese patients. These findings show that the decreased odds of mortality in critically ill obese patients is independent of the comorbidity burden or type of comorbidity.
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Gender disparities in healthcare are striking, notwithstanding an increase in female students and physicians. Underrepresentation of women in leadership positions is well-documented; however, information from low and middle-income countries (LMICs) is still sparse. The Argentinian Society of Intensive Care Medicine (SATI) aimed to characterize the gender composition in Argentine ICUs. ⋯ Our data provide evidence of an important gender gap in ICU management in a LMIC. Women were poorly represented in the leadership positions, although qualifications were similar to men. Moreover, female physicians worked more frequently in the public health subsector, usually underfinanced in LMICs-a surrogate of a gender pay gap.
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Journal of critical care · Oct 2019
Comparative StudyValidation the performance of New York Sepsis Severity Score compared with Sepsis Severity Score in predicting hospital mortality among sepsis patients.
The aim of this study was to compare the performance of the New York Sepsis Severity Score (NYSSS) with the Sepsis Severity Score (SSS) and Acute Physiology and Chronic Health Evaluation and Simplified Acute Physiology Scores for predicting mortality in sepsis patients. ⋯ The SSS had better discrimination and overall performance than the NYSSS. However, both sepsis severity scores were poorly calibrated.
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Journal of critical care · Oct 2019
Observational StudyOutcomes of emergency laparotomy in patients on extracorporeal membrane oxygenation for severe respiratory failure: A retrospective, observational cohort study.
There is a paucity of literature to support undertaking emergency laparotomy when indicated in patients supported on ECMO. Our study aims to identify the prevalence, outcomes and complications of this high risk surgery at a large ECMO centre. ⋯ Survival to hospital discharge is possible following emergency laparotomy on ECMO, however the mortality is higher than for those patients not requiring laparotomy, this likely reflects the severity of underlying organ failure rather than the surgery itself. Our service's collocation with a general surgical service has made this development in care possible. ECMO service planning should consider general surgical provision.