Journal of critical care
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Journal of critical care · Dec 2016
Individual-specific principal component analysis of circulating inflammatory mediators predicts early organ dysfunction in trauma patients.
We hypothesized that early inflammation can drive, or impact, later multiple organ dysfunction syndrome (MODS), that patient-specific principal component analysis (PCA) of circulating inflammatory mediators could reveal conserved dynamic responses which would not be apparent from the unprocessed data, and that this computational approach could segregate trauma patients with regard to subsequent MODS. ⋯ Identification of patient-specific "core responses" can lead to early segregation of diverse trauma patients with regard to later MODS. Hence, we suggest that a focus on dynamic inflammatory networks rather than individual biomarkers is warranted.
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Journal of critical care · Dec 2016
Validation of the Critical-Care Pain Observation Tool in brain-injured critically ill adults.
Pain is a common symptom in the intensive care unit (ICU). Brain-injured patients are often unable to reliably self-report their pain, calling forth the need to use behavioral scales such as the Critical-Care Pain Observation Tool (CPOT). This study aimed to test the reliability and validity of the CPOT use with brain-injured ICU adults. ⋯ Overall, the CPOT use was found to be reliable and valid in this patient group and is new evidence fulfilling an important gap highlighted in the Society of Critical Care Medicine practice guidelines.
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Journal of critical care · Dec 2016
Observational StudyThe association between hemoglobin concentration and neurologic outcome after cardiac arrest.
The purpose of the study is to determine the association between hemoglobin concentration (Hgb) and neurologic outcome in postarrest patients. ⋯ Higher Hgb after cardiac arrest is associated with favorable neurologic outcome, particularly within the first 6 hours. It is unclear if this effect is due to impaired oxygen delivery or if Hgb is a marker for more severe illness.
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Journal of critical care · Dec 2016
Crossing the handover chasm: Clinicians' perceptions of barriers to the early detection and timely management of severe sepsis and septic shock.
The purpose was to identify barriers to the early detection and timely management of severe sepsis throughout the emergency department (ED), general ward (GW), intermediate care unit (IMC), and the intensive care unit (ICU). ⋯ Our study shows the need to improve intra- and interunit handover processes in hospital care, which would ensure a holistic treatment concept, thereby improving patient care.
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Journal of critical care · Dec 2016
Cost-effectiveness analysis of early point-of-care lactate testing in the emergency department.
To determine the cost-effectiveness of implementing a point-of-care (POC) Lactate Program in the emergency department (ED) for patients with suspected sepsis to identify patients who can benefit from early resuscitation. ⋯ Implementing a POC Lactate Program for screening ED patients with suspected sepsis is a cost-effective intervention to identify patients responsive to early resuscitation.