Journal of critical care
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Journal of critical care · Feb 2018
Implementation of a risk-stratified opioid weaning protocol in a pediatric intensive care unit.
Opioids are important in the care of critically ill children. However, their use is associated with complications including delirium, dependence, withdrawal, and bowel dysfunction. Our aim was to implement a risk-stratified opioid weaning protocol to reduce the duration of opioids without increasing the incidence of withdrawal. ⋯ We implemented a risk-stratified opioid weaning protocol for critically ill children that resulted in reduction in opioid exposure without an increase in withdrawal. There was no difference in the LOS.
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Journal of critical care · Feb 2018
Review Meta AnalysisHigh-flow oxygen therapy in immunocompromised patients with acute respiratory failure: A review and meta-analysis.
Acute respiratory failure remains a common hazardous complication in immunocompromised patients and is associated with increased mortality rates when endotracheal intubation is need. We aimed to evaluate the effect of high-flow nasal cannula oxygen therapy (HFNC) compared with other oxygen technique for this patient population. ⋯ The results of current meta-analysis suggest that use of HFNC significantly improve outcomes of acute respiratory failure in immunocompromised patients. Owing to the quality of the included studies, further adequately powered randomized controlled trials are needed to confirm our results.
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Journal of critical care · Feb 2018
Increased DNA damage and increased apoptosis and necrosis in patients with severe sepsis and septic shock.
Reactive oxygen species (ROS) has a key role in the pathogenesis of sepsis. We wanted to evaluate ROS-associated lymphocyte necrosis and apoptosis. ⋯ The level of 8-OHdG increased with severe sepsis or septic shock. There were significant differences between the pre- and post-treatment values for apoptotic cell frequency (4.21±3.15 vs. 3.82±3.07, P<0.05) and necrotic cell frequency (4.75±3.61 vs. 4.09±3.37, P<0.05). Apoptosis and necrosis was increased during severe sepsis and septic shock, and apoptosis increase also continued after recovery, but necrosis decreased following disease recovery. CONCLUSıONS: In patients with severe sepsis or septic shock, apoptosis and necrosis were increased along with increased 8-OHdG level.
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Journal of critical care · Feb 2018
Multicenter StudyEffects of polymyxin B hemoperfusion on hemodynamics and prognosis in septic shock patients.
We designed this study to examine the clinical effects of polymyxin B hemoperfusion (PMX-HP) in septic shock patients. ⋯ PMX-HP may have potential benefits for hemodynamic and prognostic outcomes in septic shock patients with intra-abdominal or gram-negative bacterial infection.
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Journal of critical care · Feb 2018
Randomized Controlled Trial Comparative StudyA randomized controlled trial of one bag vs. two bag system of fluid delivery in children with diabetic ketoacidosis: Experience from a developing country.
To compare one vs. two bag system with respect to blood glucose variability (BGV), time for resolution of acidosis and incidence of hypoglycemia, hypokalemia, and cerebral edema in children with diabetic ketoacidosis (DKA). ⋯ The one and two bag systems were similar to each other with respect to BGV, incidence of complications and time to resolution of acidosis.