Journal of critical care
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Journal of critical care · Apr 2019
ReviewDecision-making in ICU - A systematic review of factors considered important by ICU clinician decision makers with regard to ICU triage decisions.
The ICU is a scarce resource within a high-stress, high-stakes, time-sensitive environment where critically ill patients with life-threatening conditions receive expensive life-sustaining care under the guidance of expert qualified personnel. The implications of decisions such as suitability for admission into ICU are potentially dire and difficult. ⋯ The complex and dynamic ICU triage decision is affected by numerous interacting factors. The literature provides some indication of these factors, but fail to show complexities and interactions between them. A decision tree is proposed. Further research should include a reflection on how decisions for admission to ICU are made, such that a better understanding of these processes can be achieved allowing for improved individual and group consistency.
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Journal of critical care · Apr 2019
Multicenter Study Observational StudyEpidemiology of disseminated intravascular coagulation in sepsis and validation of scoring systems.
We investigated the epidemiology and outcome of disseminated intravascular coagulation (DIC) in patients with sepsis. ⋯ Patients with sepsis and DIC have high mortality. However, the DIC are not independently associated with in-hospital mortality.
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Journal of critical care · Apr 2019
Transient acute kidney injury after major abdominal surgery increases chronic kidney disease risk and 1-year mortality.
We conducted a retrospective cohort study to determine incidences of transient and persistent acute kidney injury (AKI) after major abdominal surgery and their impacts on long-term outcome. ⋯ Although most AKI cases after major abdominal surgery recover completely within 7 days, even these patients with transient AKI are at higher risk for 1-year mortality and chronic kidney disease progression compared to patients without AKI.
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Journal of critical care · Apr 2019
ReviewVentilator-associated pneumonia: The central role of transcolonization.
Ventilator-associated pneumonia remain frequent and serious diseases since they are associated with considerable crude mortality. Pathophysiology is centered on modifications of regional bacterial flora, especially tracheobronchial tree and oropharyngeal sphere. ⋯ Although modification of bacterial flora has been largely studied, the mechanism which underlays the ability of the implantation, growing and interactions with the local microbiome that leads to the observed transcolonization remains to be more clearly deciphered. The aim of our review is to emphasize the cornerstone importance of the "transcolonization" as a nosological entity playing a central role in ventilator-associated pneumonia.