Journal of critical care
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Journal of critical care · Aug 2016
A minimum blood glucose value less than or equal to 120 mg/dL under glycemic control is associated with increased 14-day mortality in nondiabetic intensive care unit patients with sepsis and stress hyperglycemia.
Hyperglycemia is common in critically ill patients, but results of previous trials on glycemic control have been controversial. This study aimed to investigate whether the minimum blood glucose value during the first 72 hours after admission (72-min-BGV) was associated with mortality in patients with severe sepsis. ⋯ A 72-min-BGV less than or equal to 120 mg/dL was an independent risk factor for 14-day mortality in nondiabetic patients with hyperglycemia admitted to our intensive care unit due to severe sepsis, but not in diabetic patients under the same setting.
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Journal of critical care · Aug 2016
Neutrophil gelatinase-associated lipocalin levels during the first 48 hours of intensive care may indicate upcoming acute kidney injury.
The recognition of acute kidney injury (AKI) as early as possible is important in the intensive care unit. This study proposes that serum and urine levels of neutrophil gelatinase-associated lipocalin (NGAL) may be used for this purpose. ⋯ Most AKI cases were diagnosed within the first 48 hours after admission, and NGAL was useful for predicting upcoming AKI.
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Journal of critical care · Aug 2016
Observational StudyCharacteristics and outcome of patients with the ICU Admission diagnosis of status epilepticus in Australia and New Zealand.
Status epilepticus (SE) is a neurological emergency and may lead to Intensive Care Unit (ICU) admission. However, little is known about the characteristics and outcome of patients with the ICU admission diagnosis of SE. ⋯ Over a 14-year period in ANZ, there have been major changes in the features, management and outcome of patients admitted to ICU with the primary admission diagnosis of SE such that their ICU mortality is now <1%.
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Journal of critical care · Aug 2016
Safety of peripheral administration of phenylephrine in a neurologic intensive care unit: A pilot study.
Integral to the management of the neurocritically injured patient are the prevention and treatment of hypotension, maintenance of cerebral perfusion pressure, and occasionally blood pressure augmentation. When adequate volume resuscitation fails to meet perfusion needs, vasopressors are often used to restore end-organ perfusion. This has historically necessitated central venous access given well-documented incidence of extravasation injuries associated with peripheral administration of vasopressors. ⋯ We were able to administer peripheral phenylephrine, up to a dose of 2 μg/(kg min), for an average of 14.29hours (1-54.3) in 20 patients with only 1 possible minor complication and no major complications. This was achieved by adding additional safety measures in our computerized physician order entry system and additional nurse-driven safety protocols. Thus, with careful monitoring and safety precautions, peripheral administration of phenylephrine at an optimized concentration appears to have an acceptable safety profile for use in the neurocritical care unit up to a mean infusion time of 14hours.