Journal of critical care
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Journal of critical care · Jun 2014
Randomized Controlled Trial Multicenter StudyDoes the achievement of an intermediate glycemic target reduce organ failure and mortality? A post hoc analysis of the Glucontrol trial.
This research evaluates the impact of the achievement of an intermediate target glycemic band on the severity of organ failure and mortality. ⋯ There was no difference in organ failure in the Glucontrol study based on intention to treat to different glycemic targets. Actual outcomes and significant crossover indicate that this result may not be due to the difference in target or treatment. Odds ratios-associated achieving an intermediate 4.0 to 7.0 mmol/L range improved outcome.
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Journal of critical care · Jun 2014
Randomized Controlled Trial Multicenter StudyHeparin-induced thrombocytopenia in the critically ill: Interpreting the 4Ts test in a randomized trial.
Thrombocytopenia occurs in 20% to 45% of critically ill medical-surgical patients. The 4Ts heparin-induced thrombocytopenia (HIT) score (with 4 domains: Thrombocytopenia, Timing of thrombocytopenia, Thrombosis and oTher reason[s] for thrombocytopenia) might reliably identify patients at low risk for HIT. Interobserver agreement on 4Ts scoring is uncertain in this setting. ⋯ Real-time 4Ts scoring by research coordinators at the time of testing for HIT was not consistent with 4Ts scores obtained by central adjudicators. The results of this comprehensive HIT testing highlight the need for further research to improve the assessment of PTP scoring of HIT for critically ill patients.
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Journal of critical care · Jun 2014
Randomized Controlled Trial Multicenter StudyRelative adrenal insufficiency in critically ill patient after rapid sequence intubation: KETASED ancillary study.
Relative adrenal insufficiency (RAI) has been reported as a predictor of mortality in septic patient; however, its effects on mortality and outcomes for critically ill patients remain debatable. The objective of this study was to assess the effect of RAI on prognostic outcomes in patients after out-of-hospital rapid sequence intubation (RSI) and factors associated with the onset of RAI. ⋯ In critically ill patients who require RSI, RAI is common and is not associated with worsened outcomes in our cohort.
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Journal of critical care · Jun 2014
Randomized Controlled TrialThe effect of the arterial catheter insertion technique on the success of radial artery cannulation: A prospective and randomized study.
The main objective of the current investigation was to compare a single wall puncture to vessel transfixing on the success of radial artery cannulation by resident physicians. ⋯ Our findings suggest that there does not appear to be an advantage of the transfixing technique over the single wall puncture method for cannulating the radial artery by resident physicians. Cannulation was achieved in shorter time using the single wall puncture technique even after accounting for differences between residents and prior levels of experience.
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Journal of critical care · Jun 2014
Randomized Controlled TrialCycling-off modes during pressure support ventilation: Effects on breathing pattern, patient effort, and comfort.
Expiratory asynchrony during pressure support ventilation (PSV) has been recognized as a cause of patient discomfort, increased workload, and impaired weaning process. We evaluated breathing pattern, patient comfort, and patient effort during PSV comparing 2 flow termination criteria: fixed at 5% of peak inspiratory flow vs automatic, real-time, breath-by-breath adjustment within the range of 5% to 55%. ⋯ When compared with a fixed termination criterion, the use of a variable, real-time-adjusted termination criterion improved some indices of patient-ventilator synchrony, producing better breathing pattern, less discomfort, and slightly lower patient effort during PSV.