Journal of critical care
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Journal of critical care · Feb 2017
Review Historical ArticleCorticosteroids and neuromuscular blockers in development of critical illness neuromuscular abnormalities: A historical review.
Weakness is common in critically ill patients, associated with prolonged mechanical ventilation and increased mortality. Corticosteroids and neuromuscular blockade (NMB) administration have been implicated as etiologies of acquired weakness in the intensive care unit. Medical literature since the 1970s is replete with case reports and small case series of patients with weakness after receiving high-dose corticosteroids, prolonged NMB, or both. ⋯ This may reflect changes in clinical practice, such as a reduction in steroid dosing, use of cisatracurium besylate instead of aminosteroid NMBs, improved glycemic control, or trends in minimizing mechanical ventilatory support. Thus, based on the most recent and high-quality literature, neither corticosteroids in commonly used doses nor NMB is associated with increased duration of mechanical ventilation, the greatest morbidity of weakness. Minimizing ventilator support as soon as the patient's condition allows may be associated with a reduction in weakness-related morbidity.
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Journal of critical care · Feb 2017
Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock.
Lactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >4mmol/L, we compared mortality prediction between a subsequent lactate ≥4mmol/L to a <10% and <20% decrease between initial and subsequent lactate values. ⋯ A subsequent lactate ≥4mmol/L and lactate reduction <20% were associated with increased in-hospital mortality, whereas a lactate reduction <10% was not. Sensitivity and specificity are different between these parameters.
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Journal of critical care · Feb 2017
Derivation and validation of the automated search algorithms to identify cognitive impairment and dementia in electronic health records.
Long-term cognitive impairment is a common and important problem in survivors of critical illness. We developed electronic search algorithms to identify cognitive impairment and dementia from the electronic medical records (EMRs) that provide opportunity for big data analysis. ⋯ Automated EMR data extractions for cognitive impairment and dementia are reliable and accurate and can serve as acceptable and efficient alternatives to time-consuming manual data review.
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Journal of critical care · Feb 2017
The relationship between executive dysfunction, depression, and mental health-related quality of life in survivors of critical illness: Results from the BRAIN-ICU investigation.
Although executive dysfunction and depression are common among intensive care unit (ICU) survivors, their relationship has not been evaluated in this population. We sought to determine (1) if executive dysfunction is independently associated with severity of depressive symptoms or worse mental health-related quality of life (HRQOL) in ICU survivors, and (2) if age modifies these associations. ⋯ Regardless of age, executive dysfunction was independently associated with subsequent worse severity of depressive symptoms and worse mental HRQOL. Executive dysfunction may have a key role in the development of depression.
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Journal of critical care · Feb 2017
Observational StudyRelevance of serum sclerostin concentrations in critically ill patients.
Sclerostin is a negative regulator of bone metabolism and associated with chronic morbidities. We investigated circulating sclerostin in critically ill patients. ⋯ Serum sclerostin concentrations are significantly elevated in critically ill patients, linked to renal or hepatic organ failure, and associated with bone resorption markers, supporting its value as a potential tool for the assessment of ICU-related metabolic bone disease.