Journal of critical care
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Journal of critical care · Feb 2019
Comparative StudyImpact of chronic hypertension on time to goal mean arterial pressure and clinical outcomes in critically ill patients with septic shock requiring vasopressors.
Mean arterial pressure (MAP) reflects the adequacy of tissue perfusion. In septic shock, vasopressors are recommended to target MAP ≥65 mmHg. The impact of chronic hypertension (HTN) on MAP achievement and outcomes are uncertain. ⋯ Patients with HTN achieved goal MAP more rapidly but had higher odds of mortality.
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Journal of critical care · Feb 2019
An analysis of homeless patients in the United States requiring ICU admission.
To assess how homelessness impacts mortality and length of stay (LOS) among select the intensive care unit (ICU) patients. ⋯ Critically ill homeless patients with sepsis had longer hospital LOS but similar ICU LOS and mortality risk compared to non-homeless patients. Homelessness was not associated with increased LOS in the diabetes or alcohol and drug related groups.
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Journal of critical care · Feb 2019
Observational StudyImpact of maintenance, resuscitation and unintended fluid therapy on global fluid load after elective coronary artery bypass surgery.
Standardized protocols are provided for maintenance and replacement fluid therapy in critically ill patients. However, unintended fluid sources (analgesics, antibiotics and other drugs) are not always taken into account when prescribing intravenous fluid therapy. We evaluated the extent to which maintenance, resuscitation and unintended fluids contributed to total fluid load in elective coronary artery bypass graft patients during their ICU stay. ⋯ Postoperative maintenance and resuscitation fluids are responsible for most of the observed total fluid load on the first two days after elective coronary artery bypass graft surgery. Unintended fluid load is underestimated and has to be taken into account during fluid prescription.
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Journal of critical care · Feb 2019
Focused echocardiography: Dyad versus individual training in an authentic clinical context.
Echocardiography is increasingly being taught to intensive care unit residents. Current training methods require teachers to closely supervise trainees individually, and are time-intensive. To reduce the time burden, dyad training (training in pairs) under simulation conditions has been shown to be non-inferior to individual training. We aimed to validate these preliminary results for focused subcostal echocardiography (FSE), in an authentic clinical context. ⋯ Assuming a 1-point non-inferiority threshold for the mean composite score, dyad training for FSE was non-inferior to individual training.