Journal of critical care
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Journal of critical care · Feb 2019
Outcomes comparison in patients admitted to low complexity rural and urban intensive care units in the Veterans Health Administration.
To evaluate mortality, length of stay, and inter-hospital transfer in the Veteran Health Administration (VHA) among low complexity Intensive Care Unit (ICU) patients. ⋯ Despite challenges, low complexity ICUs in rural VA facilities fare similarly to urban counterparts. Being part of a national healthcare system may have benefits to explore in sustaining critical care access in rural areas outside the VA healthcare system.
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Journal of critical care · Feb 2019
Multicenter StudyMeasuring quality indicators to improve pain management in critically ill patients.
To evaluate the quality of pain assessment in Dutch ICUs and its room for improvement. ⋯ There is substantial variation in pain assessment across Dutch ICUs, and ample room for improvement. With this study we took a first step towards quality assurance of pain assessment in Dutch ICUs.
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Journal of critical care · Feb 2019
Extracorporeal membrane oxygenation in Korea - Trends and impact of hospital volume on outcome: Analysis of national insurance data 2009-2014.
ECMO use has increased lately. However, differences between adult ECMO and non-ECMO patients admitted to the ICU remain unstudied. In terms of volume-outcome relationship, the impact of ECMO volume on survival has not been validated in a real world cohort. ⋯ The prevalence of ECMO among ICU patients was 0.5%. The expenditure and in-hospital mortality of the ECMO group were four and five times higher than non-ECMO group respectively. An annual hospital ECMO volume ≥ 20 may improve survival to hospital discharge.
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Journal of critical care · Feb 2019
Observational StudyVitamin K deficiency in critical ill patients; a prospective observational study.
Vitamin K is a cofactor for proteins involved in cardiovascular health, bone metabolism and cancer. Measuring uncarboxylated prothrombin, also termed as "protein induced by vitamin K absence or antagonism for factor II (PIVKA-II)", has been used to assess vitamin K status. High levels may indicate vitamin K deficiency. The aim of this study was to measure PIVKA-II and prothrombin time (PT-INR) in intensive care (ICU) patients and correlate vitamin K status with mortality. ⋯ Intensive care patients have increased PIVKA-II levels at admission, which increases during the ICU stay, especially in cardiac arrest patients. There were no correlations between PIVKA-II and PT-INR, SOFA score or mortality. Further studies are needed to determine why PIVKA-II increases and whether high PIVKA-II levels in ICU patients affect long-term mortality or morbidity.
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Journal of critical care · Feb 2019
Observational StudyRapid response team review of hemodynamically unstable ward patients: The accuracy of cardiac index assessment.
Intensive care doctors commonly attend rapid response team (RRT) reviews of hospital-ward patients with hemodynamic instability and estimate the patient's likely cardiac index (CI). We aimed to non-invasively measure the CI of such patients and assess the level of agreement between such measurements and clinically estimated CI categories (low <2L/min/m2, normal 2-2.99L/min/m2 or high ≥3L/min/m2). ⋯ Non-invasive CI measurement was possible in almost all hospital-ward patients triggering RRT review for hemodynamic instability. In such patients, the CI was high, and intensive care clinicians were unable to identify a low or a high CI state.