Journal of critical care
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Journal of critical care · Jun 2023
Usefulness of differential time to positivity between catheter and peripheral blood cultures for diagnosing catheter-related bloodstream infection: Data analysis from routine clinical practice in the intensive care unit.
To assess the accuracy of differential time to positivity (DTP) method for the diagnosis of catheter-related bloodstream infections (CRBSI) in the routine practice of our intensive care unit (ICU). ⋯ The routine use of the DTP method at any cutoff point has inadequate accuracy in detecting CRBSI in the real every day clinical practice. Not even the ratio between times to positivity seems to be clinically useful.
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Journal of critical care · Jun 2023
Observational StudyHigh respiratory effort decreases splanchnic and peripheral perfusion in patients with respiratory failure during mechanical ventilation.
This study aimed to evaluate the effects of high respiratory effort(HRE) on spleen, kidney, intestine, and peripheral perfusion in patients with respiratory failure during mechanical ventilation. ⋯ HRE could decrease perfusion of peripheral tissues and splanchnic organs. The status of HRE should be avoided to protect splanchnic and peripheral organs in mechanically ventilated patients.
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Journal of critical care · Jun 2023
Diagnosing acute kidney injury ahead of time in critically ill septic patients using kinetic estimated glomerular filtration rate.
Accurate and actionable diagnosis of Acute Kidney Injury (AKI) ahead of time is important to prevent or mitigate renal insufficiency. The purpose of this study was to evaluate the performance of Kinetic estimated Glomerular Filtration Rate (KeGFR) in timely predicting AKI in critically ill septic patients. ⋯ Predictive performance of KeGFR combined with UO criteria for diagnosing AKI is excellent. Compared to KDIGO, deterioration of renal function was identified earlier, most prominently for lower stages of AKI. This may shift the actionable window for preventing and mitigating renal insufficiency.
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Journal of critical care · Jun 2023
Optimal positive end-expiratory pressure reduces right ventricular dysfunction in COVID-19 patients on venovenous extracorporeal membrane oxygenation: A retrospective single-center study.
While mechanical ventilation practices on venovenous extracorporeal membrane oxygenation (VV ECMO) are variable, most institutions utilize a lung rest strategy utilizing relatively low positive end-expiratory pressure (PEEP). The effect of PEEP titration using esophageal manometry during VV ECMO on pulmonary and cardiac function is unknown. This was a retrospective study of 69 patients initiated on VV ECMO between March 2020 through November 2021. ⋯ The optimal PEEP strategy had higher levels of applied PEEP (17.9 vs. 10.8 cm H2O on day 2 of ECMO), decreased incidence of hemodynamically significant RV dysfunction (4.55% vs. 44.0%, p = 0.0001), and higher survival to decannulation (72.7% vs. 44.0%, p = 0.022). Survival to discharge did not reach statistical significance (61.4% vs. 44.0%, p = 0.211). In univariate logistic regression analysis, optimal PEEP was associated with less hemodynamically significant RV dysfunction with an odds ratio (OR) of 0.06 (95% confidence interval [CI] = 0.01-0.27, p = 0.0008) and increased survival to decannulation with an OR of 3.39 (95% CI 1.23-9.79), p = 0.02), though other confounding factors may have contributed.