Journal of critical care
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Journal of critical care · Dec 2019
Observational StudyAssociation between DNA and RNA oxidative damage and mortality in septic patients.
DNA and RNA oxidative damage occurs during sepsis. Higher urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels (from oxidation of guanosine from DNA) have been found in non-surviving patients than in surviving septic patients. However, the relation between DNA and RNA oxidative damage and mortality in septic patients has never been published; thus, the objective of this study was to determine the existence of this association. ⋯ The new findings from our study were that oxidative DNA and RNA damage in septic patients was associated with mortality and lipid peroxidation.
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Journal of critical care · Dec 2019
Sepsis quality in safety-net hospitals: An analysis of Medicare's SEP-1 performance measure.
Newly enacted policies at the state and federal level in the United States require acute care hospitals to engage in sepsis quality improvement. However, responding to these policies requires considerable resources and may disproportionately burden safety-net hospitals. To better understand this issue, we analyzed the relationship between hospital safety-net status and performance on Medicare's SEP-1 quality measure. ⋯ Existing sepsis policies may harm safety-net hospitals and widen health disparities. Our findings suggest that strategies to promote collaboration among hospitals may be an avenue for sepsis performance improvement in safety-net hospitals.
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Journal of critical care · Dec 2019
Prospective validation and refinement of the APPROACH cardiovascular surgical intensive care unit readmission score.
The APPROACH cardiovascular surgical intensive care unit (CVICU) readmission score has excellent discrimination and calibration for CVICU readmission after discharge to a surgical ward; however, it has not been prospectively validated. ⋯ In a prospective validation cohort, the APPROACH CVICU readmission risk score had good discrimination and could be operationalized in future research and clinical practice.
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Journal of critical care · Dec 2019
Hemodynamic profiles following digoxin use in patients with sepsis in the ICU.
To explore the impact of digoxin on hemodynamic parameters in patients with sepsis and tachycardia admitted to the intensive care unit. ⋯ Early digoxin administration in patients with sepsis and tachycardia is uncommon but associated with improvements of hemodynamic parameters. These preliminary results will help formulate future hypotheses for focused trials on utility, efficacy and safety of digoxin in sepsis.
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Journal of critical care · Dec 2019
The incidence, predictors and outcomes of QTc prolongation in critically ill patients.
To study the incidence, predictors and outcomes of QTc prolongation (≥500 ms) during ICU admission. ⋯ A QTc ≥500 ms likely represents a marker of illness severity modulated by several risk factors, and carries no independent association with clinically-significant ventricular tachyarrhythmias. Thus, cessation of QT-prolonging medications to prevent arrhythmias may lack clinical benefit.