Journal of critical care
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Journal of critical care · Apr 2017
Factors predicting failure of noninvasive ventilation assist for preventing reintubation among medical critically ill patients.
Reintubation after failed extubation is associated with high mortality. Noninvasive ventilation (NIV) has been used to prevent reintubation, but the results have been inconclusive. We investigated the factors predicting failure of NIV-assisted extubation among medical critically ill patients. ⋯ Respiratory failure caused by pneumonia is predictive of failure of NIV-assisted extubation.
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Journal of critical care · Apr 2017
Sepsis as 2 problems: Identifying sepsis at admission and predicting onset in the hospital using an electronic medical record-based acuity score.
Early identification and treatment improve outcomes for patients with sepsis. Current screening tools are limited. We present a new approach, recognizing that sepsis patients comprise 2 distinct and unequal populations: patients with sepsis present on admission (85%) and patients who develop sepsis in the hospital (15%) with mortality rates of 12% and 35%, respectively. ⋯ This approach yields good to excellent discriminatory performance among adult inpatients for predicting sepsis present on admission or developed within the hospital and may aid in the timely delivery of care.
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Journal of critical care · Apr 2017
Coagulation in acutely ill patients with severe chronic liver disease: Insights from thromboelastography.
There is controversy about the true coagulation state of acutely ill patients with chronic liver disease (CLD) due to simultaneous pro- and anticoagulant factor deficits and limitations of conventional coagulation tests (CCTs). Thromboelastography (TEG) may provide more physiologically relevant insights. ⋯ In acutely ill patients with CLD, TEG demonstrates delayed clot formation and weaker thrombus strength despite decreased clot lysis. This challenges the notion that such patients experience a balanced coagulation state, highlighting the complexity of their coagulopathies.
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Journal of critical care · Apr 2017
Noninvasive ventilation during acute respiratory distress syndrome in patients with cancer: Trends in use and outcome.
The objectives of our study were to describe the outcome of patients with malignancies treated for acute respiratory distress syndrome (ARDS) with noninvasive ventilation (NIV) and to evaluate factors associated with NIV failure. ⋯ Noninvasive ventilation failure in ARDS patients with malignancies is frequent and related to ARDS severity, SOFA score, and pulmonary infection-related ARDS. Noninvasive ventilation failure is associated with in-hospital mortality.
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Journal of critical care · Apr 2017
Clinical characteristics of critically ill patients with suspected influenza during the 2009-10 and 2013-14 outbreaks.
Pandemic influenza A pdm09 (pH1N1) virus was the predominant isolate identified during the 2009-10 and 2013-14 influenza outbreaks, causing significant morbidity and mortality. We describe clinical characteristics of critically ill patients during 2 pH1N1 outbreaks. ⋯ Use of adjunct oxygenation therapies and nontraditional antiviral dosing has changed significantly since the 2009 pandemic, although this has not resulted in a measurable impact on clinical outcomes.