Journal of critical care
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Journal of critical care · Aug 2017
Outcomes from extensive training in critical care echocardiography: Identifying the optimal number of practice studies required to achieve competency.
Optimal instruction and assessment of critical care ultrasound (CCUS) skills requires an assessment tool to measure learner competency and changes over time. In this study, a previously published tool was used to monitor the development of critical care echocardiography (CCE) competencies, the attainment of performance plateaus, and the extent to which previous experience influenced learning. ⋯ Supporting earlier results, the RACE scale provided a straightforward means to assess learner performance with minimal requirements for evaluator training. The results of the present study suggest that novices experience the greatest gains in competency during their first twenty practice studies, a threshold which should serve to guide training initiatives.
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Journal of critical care · Aug 2017
Novel urinary biomarkers and the early detection of acute kidney injury after open cardiac surgeries.
Acute kidney injury (AKI) is a common complication after cardiac surgery, recently, several biomarkers have been used to facilitate early detection of AKI, including Neutrophil-gelatinase-associated-lipocalin (NGAL) and Kidney-injury-molecule-1 (KIM-1).This study was carried out to study the efficacy of urinary KIM-1 and NGAL separately and in combination in relation to early detection and assessment of severity of AKI after cardiac surgeries. ⋯ urinary NGAL is early sensitive but KIM-1which appears later than but is a more specific biomarker to ischemic renal injury. Urinary microscopic examination was found to be with very high sensitivity and specificity and injury site informative. The combination of more than one biomarker increases the accuracy of early detection of AKI after cardiac surgery.
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Journal of critical care · Aug 2017
Neuromuscular blockade requirement is associated with good neurologic outcome in cardiac arrest survivors treated with targeted temperature management.
We examined the association between neuromuscular blockade (NMB) requirements and outcomes and lactate clearance in cardiac arrest survivors treated with targeted temperature management (TTM). ⋯ Continuous NMB requirement was associated with improved neurologic outcome and decreased in-hospital mortality in cardiac arrest survivors treated with TTM. The NMB requirement was not associated with lactate clearance.
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Journal of critical care · Aug 2017
Observational StudyA prospective study of fungal biomarkers to improve management of invasive fungal diseases in a mixed specialty critical care unit.
The diagnosis of invasive fungal diseases (IFD) in critical care patients (CrCP) is difficult. The study investigated the performance of a set of biomarkers for diagnosis of IFD in a mixed specialty critical care unit (CrCU). ⋯ New diagnostic criteria which incorporate these biomarkers, in particular BDG, and host factors unique to critical care patients should enhance diagnosis of IFD and positively impact antifungal stewardship programs.
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Journal of critical care · Aug 2017
Laboratory and clinical predictors of 30-day survival for patients on Extracorporeal Membrane Oxygenation (ECMO): 8-Year experience at Albert Einstein College of Medicine, Montefiore Medical Center.
Survival of patients on ECMO has remained stable in every population. Laboratory values predictors of survival are required to improve patient care. ⋯ Laboratory markers identified herein may guide the management of patients on ECMO.