Journal of critical care
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Journal of critical care · Jun 2018
Multicenter Study Observational StudyEarly glycemia and mortality in critically ill septic patients: Interaction with insulin-treated diabetes.
To investigate the relationship between dysglycemia and hospital mortality in patients with and without a preadmission diagnosis of insulin treated diabetes mellitus (ITDM). ⋯ Septic patients with a pre-existing diagnosis of ITDM show a different relationship between hospital mortality and highest glucose levels and glycemic variability in the first 24 h than those without ITDM. These findings provide a rationale for an ITDM-specific approach to the management of dysglycemia.
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Journal of critical care · Apr 2018
Randomized Controlled Trial Multicenter StudyThe study of vitamin D administration effect on CRP and Interleukin-6 as prognostic biomarkers of ventilator associated pneumonia.
In regard with the effect of immune-stimulants in the treatment of infectious diseases, the effect of vitamin D administration on the outcome of patients with Ventilator-Associated Pneumonia (VAP) with a high rate of mortality, was studied. ⋯ Our results indicate that vitamin D administration can significantly reduce the IL-6 as prognostic marker in VAP patients, and must be considered as adjunct option in the treatment of VAP patients.
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Journal of critical care · Apr 2018
Multicenter StudyMeasurement of respiratory rate by multiple raters in a clinical setting is unreliable: A cross-sectional simulation study.
To evaluate the inter-observer reliability of nurses assessing respiratory rate. ⋯ We found a wide variation in measurements of RR with both few and many observers assessing exactly the same patients.
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Journal of critical care · Apr 2018
Multicenter Study Observational StudyPrognostic significance of disseminated intravascular coagulation in patients with heat stroke in a nationwide registry.
Heat stroke (HS) induces disseminated intravascular coagulation (DIC); however, the prognostic significance of DIC in patients with HS has not yet been fully assessed in large populations. The aim of this study was to examine the prognostic significance of DIC in patients with HS using a nationwide registry. ⋯ Presence of DIC was an independent prognostic factor of hospital mortality in patients with HS. Hematological dysfunction represents potential target for specific therapies in HS.
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Journal of critical care · Apr 2018
Multicenter StudyAssociation of high mortality with extended-spectrum β-lactamase (ESBL) positive cultures in community acquired infections.
Infections due to multidrug resistant organisms have become a serious health concern worldwide. The present study was conducted to investigate the spectrum of microbial resistance pattern in the community and their effects on mortality. ⋯ Out of 5309 patients enrolled; 3822 had suspected clinical infection on admission with 1452 patients growing positive microbial cultures. Among these, 201 bacterial strains were isolated from patients who had community acquired infections. 73% were Gram negative bacilli, commonest being E. coli (63%). 63.4% E. coli and 60.7% Klebsiella isolates were ESBL producers. The mortality in ESBL positive infections was significantly higher as compared to ESBL negative infections (Odds ratio 2.756). Moreover, ESBL positive patients empirically treated with Beta Lactams+Beta Lactamase inhibitors (BL+BLI) had significantly higher mortality as compared to patients treated with carbapenems. More data from multiple centres need to be gathered to formulate appropriate antibiotic policy for critically ill patients admitted from the community.