Journal of critical care
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Journal of critical care · Jun 2020
ReviewTreating sepsis with vitamin C, thiamine, and hydrocortisone: Exploring the quest for the magic elixir.
The administration of ascorbic acid (vitamin C) alone or in combination with thiamine (vitamin B1) and corticosteroids (VCTS) has recently been hypothesized to improve hemodynamics, end-organ function, and may even increase survival in critically ill patients. There are several clinical studies that have investigated the use of vitamin C alone or VCTS in patients with sepsis and septic shock or are ongoing. Some of these studies have demonstrated its safety and potential benefit in septic patients. ⋯ These questions exist because the bulk of research regarding the efficacy of vitamin C alone or in combination with thiamine and corticosteroids in sepsis is limited to a few randomized controlled trials, retrospective before-and-after studies, and case reports. Thus, although the underlying rationale and mechanistic pathways of vitamin C and thiamine in sepsis have been well described, the clinical impact of the VCTS regimen is complex and remains to be determined. This review aims to explore the current evidence and potential benefits and adverse effects of the VCTS regimen for the treatment of sepsis.
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Journal of critical care · Jun 2020
Randomized Controlled Trial Multicenter StudyEffect of mannitol plus hypertonic saline combination versus hypertonic saline monotherapy on acute kidney injury after traumatic brain injury.
To compare the effect of mannitol plus hypertonic saline combination (MHS) versus hypertonic saline monotherapy (HS) on renal function in patients with traumatic brain injury (TBI). ⋯ The addition of mannitol to HS did not increase the risk of renal dysfunction compared to HS alone in patients with TBI.
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Journal of critical care · Jun 2020
Multicenter Study Observational StudyA new simplified and accurate sa-SOFA score.
Several remarks have been raised regarding the variables and cut-points used in the Sequential Organ Failure Assessment (SOFA) score. This study revisited the SOFA score and created a new simplified and accurate sa-SOFA score. ⋯ Keeping the conventional SOFA dimension variables, the new sa-SOFA proved to be simpler and more accurate in predicting 28-day mortality.
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Journal of critical care · Jun 2020
Multicenter Study Observational StudyCriteria deemed important by the relatives for designating a reference person for patients hospitalized in ICU.
We investigated the criteria that patients' relatives deem important for choosing, among themselves, the person best qualified to interact with the caregiving staff. ⋯ This study identifies the attributes considered by relatives to be most important for designating, among themselves, a reference person for a patient hospitalized in the ICU.
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Journal of critical care · Jun 2020
Multicenter StudyAbnormal shock index exposure and clinical outcomes among critically ill patients: A retrospective cohort analysis.
To assess the predictive value of a single abnormal shock index reading (SI ≥0.9; heart rate/systolic blood pressure [SBP]) for mortality, and association between cumulative abnormal SI exposure and mortality/morbidity. ⋯ A single SI reading ≥0.9 is a poor predictor of mortality; cumulative SI exposure is associated with greater risk of mortality/morbidity. The associations with in-hospital mortality were comparable for SI ≥0.9 or SBP ≤100-mmHg exposure. Dynamic interactions between hemodynamic variables need further evaluation among critically ill patients.