Journal of critical care
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Journal of critical care · Apr 2015
Choice of renal replacement therapy modality in intensive care units: Data from a Japanese Nationwide Administrative Claim Database.
This study was undertaken to assess recent trends of the choice of renal replacement therapy (RRT) modalities in Japanese intensive care units (ICUs). ⋯ Continuous RRT is apparently preferred in actual ICU practice, especially for hemodynamically unstable patients, and subsequent RRT modality switch is associated with mortality.
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Journal of critical care · Apr 2015
Medical intensive care unit consults occurring within 48 hours of admission: A prospective study.
Critical care consults requested shortly after admission could represent a triage error. This consult process has not been adequately assessed, and data are retrospective relying on discharge diagnoses. ⋯ Prospective examination of the consult process suggests that disease progression rather than triage error accounted for most unplanned transfers. Functional status and comorbidity predicted MICU admission rather than illness severity. Goals of care were not being discussed adequately. We did not detect differences in mortality although hospital length of stay was increased.
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Journal of critical care · Apr 2015
Computed tomography for the identification of a potential infectious source in critically ill surgical patients.
Computed tomography (CT) seems already to have an important role to identify an infectious source in the management of patients with sepsis. However, our daily clinical behavior in ordering CT imaging was never scrutinized. ⋯ Computed tomographic imaging detected an infectious source in more than 50% of cases. Our data suggest that CT should be recommended to identify a source of infection in critically ill patients. Furthermore, prospective studies are needed to investigate the potential impact of CT imaging on outcome and to define criteria when to perform a CT imaging study.
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Journal of critical care · Apr 2015
Soft tissue oxygenation and risk of mortality (STORM): An early marker of critical illness?
Tissue oxygen saturation (StO2) is a noninvasive measure that reflects changes in tissue perfusion. Rapid response teams (RRTs) assess sick inpatients to determine need for intensive care unit (ICU) admission. This determination is subjective based on parameters such as systolic blood pressure, heart rate, and pulse oximetry. Our objective was to determine if parameters readily available at RRT bedside assessment (vital signs and StO2) can predict ICU admission and inhospital mortality. ⋯ Tissue oxygen saturation may identify critical illness in patients who would not traditionally meet ICU admission criteria and thus may identify patients who benefit from closer monitoring.
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Journal of critical care · Apr 2015
Venoarterial extracorporeal membrane oxygenation for patients in shock or cardiac arrest secondary to cardiotoxicant poisoning: A cost-effectiveness analysis.
Venoarterial extracorporeal membrane oxygenation represents an emerging and recommended option to treat life-threatening cardiotoxicant poisoning. The objective of this cost-effectiveness analysis was to estimate the incremental cost-effectiveness ratio of using venoarterial extracorporeal membrane oxygenation for adults in cardiotoxicant-induced shock or cardiac arrest compared with standard care. ⋯ Venoarterial extracorporeal membrane oxygenation may be cost effective in treating cardiotoxicant poisonings.