Journal of critical care
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Journal of critical care · Dec 2014
Observational StudyImpact of positive fluid balance on critically ill surgical patients: A prospective observational study.
The purpose of this study is to determine the effect of postoperative fluid balance (FB) on subsequent outcomes in acute care surgery (ACS) patients admitted to the surgical intensive care unit (ICU). ⋯ In a cohort of critically ill ACS patients, achieving FB (-) status early during surgical ICU admission was associated with a nearly 70% reduction in the risk for mortality.
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Journal of critical care · Dec 2014
Adipose tissue lipolysis and circulating lipids in acute and subacute critical illness: Effects of shock and treatment.
The purpose of this study is to assess lipid metabolism at the tissue level in critically ill subjects. ⋯ Subcutaneous tissue lipolysis is only one of the many determinants of plasma FFAs. Routinely applied therapeutic modalities in the ICU interfere with adipose tissue metabolism.
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Journal of critical care · Dec 2014
Case ReportsChlorhexidine gluconate-impregnated central-line dressings and necrosis in complicated skin disorder patients.
Although chlorhexidine gluconate (CHG) disks have been shown to help reduce the incidence of central line-associated blood stream infections, their use can result in local skin necrosis. The effects of CHG disks on patients with complex skin pathology have not been studied. We report 6 cases of dermal necrosis associated with Biopatch (Ethicon Inc, Somerville, NJ) CHG disks in adults with complex skin pathology including those with Stevens-Johnson syndrome, toxic epidermal necrolysis syndrome, graft-versus-host disease, burns, and anasarca. ⋯ Complicated skin disorder patients represent a rare subset of the critically ill who appear prone to CHG disk necrosis. Continuous contact of CHG under occlusive dressings is speculated to predispose Stevens-Johnson syndrome, toxic epidermal necrolysis syndrome, graft-versus-host disease, and burn patients to local chemical injury secondary to loss of the epithelial tissue barrier, decreased cohesion of the epidermal-dermal junction, and increased tissue permeability. In these patients, the risk of placing the CHG disk may present more risk than using alternative antimicrobial dressings.
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Journal of critical care · Dec 2014
Admission high serum sodium is not associated with increased intensive care unit mortality risk in respiratory patients.
Because increased serum osmolarity may be lung protective, we hypothesized that increased mortality associated with increased serum sodium would be ameliorated in critically ill patients with an acute respiratory diagnosis. ⋯ High admission serum sodium is associated with increased odds for ICU death, except in respiratory patients.
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Journal of critical care · Dec 2014
The impact of an interdisciplinary electroencephalogram educational initiative for critical care trainees.
The purpose of this study is to evaluate the effectiveness of an interdisciplinary electroencephalogram (EEG) educational module for critical care training. Electroencephalogram is increasingly used for diagnosis, monitoring, and treatment decisions in critically ill patients with neurologic and nonneurologic disorders. Continuous EEG monitoring has an expanded role in the intensive care unit as an additional evaluation tool for critically ill patients with altered mental status. ⋯ An interdisciplinary approach was effective for increasing EEG knowledge in critical care fellows as measured by the assessment tools. As an added potential benefit, the pulmonary fellows also learned about sleep disorder-related EEG. This model can be replicated in other institutions for trainees of other specialties interested in critical care.