Journal of critical care
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyDeterminants of outcome in patients with a clinical suspicion of ventilator-associated pneumonia.
In the absence of a reference standard, a probabilistic approach to the diagnosis of ventilator-associated pneumonia (VAP) has been proposed; and clinician judgment augmented by microbiological tests is used to guide therapy for patients having a clinical suspicion of VAP (CSVAP). However, the correlation of both clinician judgment at the time of CSVAP and the probability of VAP with clinical outcomes is unknown. In a cohort of patients with CSVAP, we sought to determine the correlation of clinician judgment and the probability of VAP with clinical outcomes. In addition, we studied the impact of the clinical and microbiological components of CSVAP on the processes of care and outcomes. ⋯ In patients with CSVAP, clinician judgment as to the probability of VAP does not correlate with processes of care and outcomes; and its use to group patients into those with and without VAP is of limited clinical utility.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyVentilator-associated pneumonia caused by multidrug-resistant organisms or Pseudomonas aeruginosa: prevalence, incidence, risk factors, and outcomes.
The aim of this study was to clarify the prevalence and incidence of, risk factors for, and outcomes from suspected ventilator-associated pneumonia (VAP) associated with the isolation of either Pseudomonas or multidrug-resistant (MDR) bacteria ("high risk" pathogens) from respiratory secretions. ⋯ In this patient population, the incidence of high-risk organisms newly acquired during an ICU stay is low. However, the presence of high risk pathogens is associated with worse clinical outcomes.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyThe value of pretest probability and modified clinical pulmonary infection score to diagnose ventilator-associated pneumonia.
The aim of the study was to assess the utility of pretest probability and modified clinical pulmonary infection score CPIS in the diagnosis of late-onset ventilator-associated pneumonia (VAP). ⋯ Pretest probability and a modified CPIS, which excludes culture results, are of limited utility in the diagnosis of late-onset VAP.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyCorrelates of clinical failure in ventilator-associated pneumonia: insights from a large, randomized trial.
Our objective was to determine clinical variables measured at baseline and day 3 that may relate to failure of resolution of ventilator-associated pneumonia (VAP). ⋯ Clinical characteristics correlate with eventual outcomes in VAP. Failure of the Pao2/Fio2 ratio and fever to improve are independently associated with clinical failure. We suggest that clinicians follow these measures and consider integrating them in their decisions as to when to reevaluate persons with VAP who are not improving.
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Journal of critical care · Sep 2007
Randomized Controlled TrialEffects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy.
We investigated the effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy (TBI). ⋯ Therapeutic mild hypothermia provides a promising way in the intensive care unit for patients with severe TBI after craniotomy.