Journal of critical care
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The human body is a tightly controlled engineering miracle. However, medical training generally does not cover "control" (in the engineering sense) in physiology, pathophysiology, and therapeutics. A better understanding of how evolved controls maintain normal homeostasis is critical for understanding the failure mode of controlled systems, that is, disease. ⋯ Control systems are ubiquitous in physiology, although often unrecognized. Here we provide selected examples of the role of control in physiology (heart rate variability, immunity), pathophysiology (inflammation in sepsis), and therapeutic devices (diabetes and the artificial pancreas). We also present a high-level background to the concept of robustly controlled systems and examples of clinical insights using the controls framework.
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Journal of critical care · Jun 2015
Multicenter Study Comparative StudyImpact of case volume on aneurysmal subarachnoid hemorrhage outcomes.
To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners. ⋯ The noninferior outcomes at the lower SAH volume center suggests that provider expertise, not patient volume, is critical to providing high-quality specialized care.
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Journal of critical care · Jun 2015
ReviewA systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters.
The aim of this study was to collect and describe all published reports of local tissue injury or extravasation from vasopressor administration via either peripheral intravenous (IV) or central venous catheter. ⋯ Published data on tissue injury or extravasation from vasopressor administration via peripheral IVs are derived mainly from case reports. Further study is warranted to clarify the safety of vasopressor administration via peripheral IVs.
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Journal of critical care · Jun 2015
Multicenter Study Observational StudyEvolution and prognosis of long intensive care unit stay patients suffering a deterioration: A multicenter study.
The prognosis of a patient who deteriorates during a prolonged intensive care unit (ICU) stay is difficult to predict. We analyze the prognostic value of the serialized Sequential Organ Failure Assessment (SOFA) score and other variables in the early days after a complication and to build a new predictive score. ⋯ EPIPUSE model can predict mortality with a specificity and positive predictive value of 99% in some groups of patients.
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Journal of critical care · Jun 2015
Multicenter Study Observational StudyProcalcitonin-guided therapy may reduce length of antibiotic treatment in intensive care unit patients with secondary peritonitis: A multicenter retrospective study.
Because procalcitonin (PCT) might be surrogate for antimicrobial discontinuation in general intensive care units (ICUs), this study explored its use for secondary peritonitis in 4 surgical ICUs (SICUs). ⋯ Procalcitonin guidance produced 50% reduction in antibiotic duration (P < .001, log-rank test).