Journal of critical care
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Journal of critical care · Aug 2016
Elevated red cell distribution width at initiation of critical care is associated with mortality in surgical intensive care unit patients.
Recent evidence suggests that red cell distribution width (RDW) is associated with mortality in mixed cohorts of critically ill patients. Our goal was to investigate whether elevated RDW at initiation of critical care in the intensive care unit (ICU) is associated with 90-day mortality in surgical patients. ⋯ Elevated RDW at initiation of care is associated with increased odds of 90-day mortality in surgical ICU patients. These data support the need for prospective studies to determine whether RDW can improve risk stratification in surgical ICU patients.
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Journal of critical care · Aug 2016
Nosocomial infections and resistance pattern of common bacterial isolates in an intensive care unit of a tertiary hospital in Nigeria: A 4-year review.
Infection is a major determinant of clinical outcome among patients in the intensive care unit. However, these data are lacking in most developing countries; hence, we set out to describe the profile of nosocomial infection in one of the major tertiary hospitals in northern Nigeria. ⋯ Infection control practice and measures to curtail the emergence of antimicrobial resistance need to be improved.
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Journal of critical care · Aug 2016
Intracranial pressure and cerebral perfusion pressure in patients developing brain death.
We investigated whether a critical rise of intracranial pressure (ICP) leading to a loss of cerebral perfusion pressure (CPP) could serve as a surrogate marker of brain death (BD). ⋯ Brain death was universally preceded by a severe reduction of CPP, supporting loss of cerebral perfusion as a critical step in BD development. Our data show that a negative CPP is neither sufficient nor a prerequisite to diagnose BD. In BD cases with positive CPP, we speculate that arterial blood pressure dropped below a critical closing pressure, thereby causing cessation of cerebral blood flow.
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Journal of critical care · Aug 2016
EditorialNeuroscience and awareness in the dying human brain: Implications for organ donation practices.
Consciousness has 2 components: wakefulness (arousal) and awareness (perception of the self and the external environment). Functional neuroimaging has identified 2 distinctive functional networks that mediate external awareness of the surrounding environment and internal awareness of the self. Recent studies suggest that awareness is not always associated with wakefulness. ⋯ This aligns with the 5-minute no-touch time after the loss of arterial pulse, the current circulatory standard of death determination in non-heart-beating organ donation. We argue that the capacity for awareness may not be irreversibly lost after a relatively brief period of cessation of systemic circulation, and outline empirical data in support of the claim that awareness without wakefulness may be present. Obviously, if correct, this will have practical and ethical implications on organ donation practices.
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Journal of critical care · Aug 2016
Pressure attenuation during high-frequency airway clearance therapy across different size endotracheal tubes: An in vitro study.
High-frequency airway clearance therapy is a positive pressure secretion clearance modality used in pediatric and adult applications. However, pressure attenuation across different size endotracheal tubes (ETT) has not been adequately described. This study quantifies attenuation in an in vitro model. ⋯ In an in vitro model, pressure attenuation was linearly related to the inner diameter of the endotracheal tube; with decreasing attenuation as the ETT size increased.