Journal of critical care
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Journal of critical care · Dec 2016
Medication-induced and spontaneous hypoglycemia carry the same risk for hospital mortality in critically ill patients.
Hypoglycemia is associated with increased mortality, but the role of its etiology is unclear. This study aimed to examine the impact of hypoglycemia etiology on mortality risk among critically ill patients. ⋯ Medication-induced hypoglycemia appears to be equally harmful as spontaneous hypoglycemia during critical illness. Future studies should aim to identify strategies to minimize hypoglycemia regardless of etiology, while also minimizing glycemic variability associated with hypoglycemia treatment.
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Journal of critical care · Dec 2016
Prevalence and factors associated with the absence of pharmacologic venous thromboembolism prophylaxis: A cross-sectional study of Georgia intensive care units.
The need for venous thromboembolism prophylaxis is well accepted in the intensive care unit (ICU) and supported by a variety of guideline recommendations. Several studies have highlighted poor adherence to these recommendations, but it is unknown why this discrepancy exists. The aim of this study is assess the prevalence of pharmacoprophylaxis and characterize the practice of withholding prophylaxis. ⋯ Venous thromboembolism prophylaxis is commonly omitted in ICU patients, and reasons for omission vary. An elevated international normalized ratio is associated with withholding of pharmacologic prophylaxis.
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Journal of critical care · Dec 2016
Impact of early do-not-attempt-resuscitation orders on procedures and outcomes of severe sepsis.
Do-not-attempt-resuscitation (DNAR) orders are common in severe sepsis, but the impact on clinical care is not known. Our primary objective was to determine the impact of early DNAR orders on in-hospital mortality and performance of key interventional procedures among severe sepsis hospitalizations. Our secondary objective was to further investigate what patient characteristics within the sepsis DNAR population affected outcomes. ⋯ Although DNAR orders are not synonymous with "do not treat," they may unintentionally limit aggressive treatment for severe sepsis patients, especially in older adults.
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Patients and staff may experience adverse effects from exposure to noise.
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Journal of critical care · Dec 2016
Four-factor prothrombin complex concentrate for life-threatening bleeds or emergent surgery: A retrospective evaluation.
Previous trials investigating usage of four-factor prothrombin complex concentrate (4F-PCC) excluded patients with various thrombotic risk factors. The objective of this study was to evaluate the safety and effectiveness of 4F-PCC in a real-world setting based on an institutional protocol that does not have strict exclusion criteria. ⋯ 4F-PCC was associated with a notable thromboembolic risk. All patient-specific risk factors should be considered prior to administration. 4F-PCC remains a useful agent for warfarin reversal. Lack of concomitant vitamin K may contribute to INR rebound.