Journal of critical care
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Journal of critical care · Jun 2017
Predicting the incidence of portosplenomesenteric vein thrombosis in patients with acute pancreatitis using classification and regression tree algorithm.
The accurate prediction of portosplenomesenteric vein thrombosis (PVT) in patients with acute pancreatitis(AP) is very important but may also be difficult because of our insufficient understanding of the characteristics of AP-induced PVT. The purpose of this study is to design a decision tree model that provides critical factors associated with PVT using an approach that makes use of classification and regression tree (CART) algorithm. ⋯ The CART model based on serum amylase, d-dimer, Acute Physiology and Chronic Health Evaluation II, and prothrombin time is more likely to predict the occurrence of PVT induced by AP.
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Journal of critical care · Jun 2017
A description of the "event manager" role in resuscitations: A qualitative study of interviews and focus groups of resuscitation participants.
Communication during resuscitation is essential for the provision of coordinated, effective care. Previously, we observed 44% of resuscitation communication originated from participants other than the physician team leader; 65% of which was directed to the team, exclusive of the team leader. We called this outer-loop communication. ⋯ "Outer-loop" communication supports resuscitation activities. An event manager gives direction to the team, coordinates activities, and supports the team leader. We describe a new role in resuscitation in light of structural organizational theory and cognitive load with a view to incorporating this structure into resuscitation training.
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Journal of critical care · Jun 2017
Early continuous renal replacement therapy in septic acute kidney injury could be defined by its initiation within 24 hours of vasopressor infusion.
The optimal timing for the initiation of early continuous renal replacement therapy (CRRT) is uncertain and requires a practically feasible definition with acceptable evidence. ⋯ Considering the possible therapeutic measurement by physician on the basis of the results in this study, early CRRT could be defined by a Tvaso-CRRT less than 24 h.
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Journal of critical care · Jun 2017
Observational StudyContinuous electroencephalography in a mixed non-neurological intensive care population, an observational study.
Continuous electroencephalography (cEEG) improves monitoring of the brain in unconscious patients, but implementation at ICU is difficult. The present investigation shows a way to introduce cEEG at an anesthesiological ICU and discusses the first experiences. ⋯ Continuous electroencephalography recording is feasible and manageable. Automatic seizure detection was often false negative/positive; therefore, the interpretation of the cEEG should be supported by EEG-trained neurologists. Background EEG activity was not associated with outcome parameters, which suggests that background activity is a poor outcome predictor.
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Journal of critical care · Jun 2017
Community analysis of dental plaque and endotracheal tube biofilms from mechanically ventilated patients.
Mechanically ventilated patients are at risk for developing ventilator-associated pneumonia, and it has been reported that dental plaque provides a reservoir of respiratory pathogens that may aspirate to the lungs and endotracheal tube (ETT) biofilms. For the first time, metataxonomics was used to simultaneously characterize the microbiome of dental plaque, ETTs, and non-directed bronchial lavages (NBLs) in mechanically ventilated patients to determine similarities in respective microbial communities and therefore likely associations. ⋯ The high similarity between the microbiomes of dental plaque, NBLs, and ETTs suggests that the oral cavity is indeed an important site involved in microbial aspiration to the lower airway and ETT. As such, maintenance of good oral hygiene is likely to be highly important in limiting aspiration of bacteria in this vulnerable patient group.