Journal of critical care
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Journal of critical care · Oct 2020
Association between sepsis at ICU admission and mortality in patients with ICU-acquired pneumonia: An infectious second-hit model.
We explore the hypothesis that critically ill patients developing ICU-acquired pneumonia (ICU-AP) have worse outcomes and an altered inflammatory response if their ICU admission was sepsis-related. ⋯ Previous sepsis does not appear to predispose to higher mortality nor worse outcomes in patients who develop ICU-acquired pneumonia.
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Journal of critical care · Oct 2020
Observational StudyTriage of patients with fever: The Manchester triage system's predictive validity for sepsis or septic shock and seven-day mortality.
Up to 15% of patients arrive in the emergency department suffering from fever. Triage is their first contact and is responsible for the stratification of patients according to the severity of the condition for which they are presenting at the emergency department. The aim of this study is to assess the predictive validity of the Manchester Triage System in patients with fever for sepsis or septic shock and seven-day mortality. ⋯ The Manchester Triage System has demonstrated high sensitivity and negative predictive value in patients with fever diagnosed with sepsis or septic shock. For patients with sepsis or septic shock one-third of cases with an incorrectly assigned priority code were caused by incorrect application of the Manchester Triage System.
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Journal of critical care · Oct 2020
Comparative StudyAdjunctive therapy with vitamin c and thiamine in patients treated with steroids for refractory septic shock: A propensity matched before-after, case-control study.
Triple therapy with steroids, vitamin C and thiamine has been recently proposed as a safe and beneficial in patients with sepsis. In 2017, we added the use of intravenous vitamin C and thiamine in septic shock patients receiving low dose hydrocortisone because poorly responsive to vasopressors. Aim of this study is to verify whether triple therapy rather than steroids alone can improve outcome in patients with refractory shock. ⋯ Although with significant limitations, our experience indicated that triple therapy seems to provide an improvement of clinical outcomes in patients with refractory septic shock.
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Journal of critical care · Oct 2020
What can be learned from crude intensive care unit mortality? Methodological implications.
Demonstrate the practical range of information that can be obtained about ICU mortality/survival from limited administrative data. ⋯ Simple calculations using the few variables found in administrative database enhanced information provided by the crude mortality rate and demonstrated that temporal patterns of mortality change as stay lengthens. These results highlight the limitations of just using overall crude mortality rates.
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Journal of critical care · Oct 2020
Observational StudyRisk of incident bleeding after acute kidney injury: A retrospective cohort study.
End-stage kidney disease (ESKD) causes bleeding diathesis; however, whether these findings are extrapolable to acute kidney injury (AKI) remains uncertain. We assessed whether AKI is associated with an increased risk of bleeding. ⋯ AKI-requiring dialysis was associated with incident bleeding, independent of anticoagulant administration. Studies are needed to better understand how AKI affects coagulation and clinical outcomes.