Journal of critical care
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Journal of critical care · Feb 2018
Positive end-expiratory pressure adjusted for intra-abdominal pressure - A pilot study.
Intra-abdominal hypertension (IAH) is associated with impaired respiratory function. Animal data suggest that positive end-expiratory pressure (PEEP) levels adjusted to intra-abdominal pressure (IAP) levels may counteract IAH-induced respiratory dysfunction. In this pilot study, our aim was to assess whether PEEP adjusted for IAP can be applied safely in patients with IAH. ⋯ PEEP=100% of IAP was not well-tolerated and only marginally improved oxygenation in ventilated patients with IAH.
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Journal of critical care · Feb 2018
Observational StudyRisk factors and outcomes of critically ill patients with acute brain failure: A novel end point.
To determine the incidence, risk factors and outcomes of acute brain failure (ABF) in a mixed medical and surgical cohort of critically ill patients and its effect on ICU & hospital mortality. ⋯ ABF is a common complication of critical illness and is associated with increased short and long term mortality. The risk of ABF was particularly high in older patients with baseline dementia, COPD, diabetes, liver and renal disease and those treated with invasive mechanical ventilation.
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Journal of critical care · Feb 2018
Neutrophil CD64, C-reactive protein, and procalcitonin in the identification of sepsis in the ICU - Post-test probabilities.
We were interested in whether C-reactive protein (CRP) and procalcitonin (PCT) distinguish sepsis from non-septic controls and whether a combination of CRP, PCT, and neutrophil CD64 improves identification of sepsis in the intensive care unit (ICU). ⋯ Neutrophil CD64 expression was superior to PCT and CRP for the identification of sepsis in ICU. Positive post-test probability for any combinations of simultaneously analyzed CRP, PCT and CD64 showed improved diagnostic accuracy for sepsis. This approach may be useful for guiding antibiotic treatment in ICU.
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Journal of critical care · Feb 2018
Factors associated with in-hospital mortality among critically ill surgical patients with multidrug-resistant Gram-negative infections.
Multidrug-resistant (MDR) Gram-negative infection increases risk of mortality, other complications, and costs. The objective of this study was to determine the prevalence of and identify factors associated with in-hospital mortality among critically ill surgical patients. ⋯ MDR Gram-negative infection is associated with significant in-hospital mortality among critically ill surgical patients. Source control, along with prior ICU LOS, mechanical ventilation status, vasopressor use, and definitive antibiotic choice, are important predictors of survival in this population.
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Journal of critical care · Feb 2018
Clinical management of pressure control ventilation: An algorithmic method of patient ventilatory management to address "forgotten but important variables".
Pressure controlled ventilation is a common mode of ventilation used to manage both adult and pediatric populations. However, there is very little evidence that distinguishes the efficacy of pressure controlled ventilation over that of volume controlled ventilation in the adult population. This gap in the literature may be due to the absence of a consistent and systematic algorithm for managing pressure controlled ventilation. ⋯ This algorithmic approach highlights the need for clinicians to have a comprehensive conceptual understanding of mechanical ventilation, pulmonary physiology, and interpretation of ventilator graphics in order to best care for patients receiving pressure controlled ventilation. The objective of identifying a systematic approach to managing pressure controlled ventilation is to provide a more generalizable and equitable approach to management of the ICU patient. Ideally, a consistent approach to managing pressure controlled ventilation in the adult population will glean more reliable information regarding actual patient outcomes, as well as the efficacy of pressure controlled ventilation when compared to volume controlled ventilation.