Journal of critical care
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Journal of critical care · Dec 2014
Acute kidney injury in critical care: Experience of a conservative strategy.
Renal replacement therapy (RRT) is a major supportive treatment of acute kidney injury (AKI) in intensive care unit (ICU), but the timing of its initiation remains open to debate. ⋯ A conservative approach of AKI was not associated with increased mortality.
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Journal of critical care · Dec 2014
Observational StudyVolume of fluids administered during resuscitation for severe sepsis and septic shock and the development of the acute respiratory distress syndrome.
The purpose of this study was to examine the association between the volume of intravenous (IV) fluids administered in the resuscitative phase of severe sepsis and septic shock and the development of the acute respiratory distress syndrome (ARDS). ⋯ For patients hospitalized for severe sepsis and septic shock, fluid administration to improve end-organ perfusion should remain the top priority in early resuscitation despite the potential risk of inducing ARDS.
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Journal of critical care · Dec 2014
Incidence and long-term outcomes of critically ill adult patients with moderate-to-severe diabetic ketoacidosis: Retrospective matched cohort study.
The objective of this study was to describe the clinical outcomes and treatment intensity of adult intensive care unit (ICU) patients with moderate-to-severe diabetic ketoacidosis (DKA). We aimed also to compare their clinical course with matched non-DKA ICU controls and to identify prognostic factors for mortality and hospital readmission within 1 year. ⋯ Diabetic ketoacidosis necessitating ICU admission is associated with considerable resource utilization and long-term risk for death. Interventions aimed to improve compliance with therapy may prevent readmissions and improve the long-term outcome.
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Journal of critical care · Dec 2014
Is pressure-regulated volume control mode appropriate for severely obstructed patients?
Management of mechanical ventilation in severely obstructed patients remains controversial. Pressure-regulated volume control ventilation (PRVCV) has been suggested to be the best option, as it should ensure a prefixed tidal volume at the lowest peak inspiratory pressure. We sought to determine the accuracy of the delivered volume, compared with the programmed volume, when using PRVCV. ⋯ In high-resistance simulations, the delivered volume was lower when using PCV or PRVCV modes than VCV mode. Pressure control ventilation or PRVCV may fail to provide programmed TV, ultimately leading to hypoventilation of the patient.
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Journal of critical care · Dec 2014
The Durban World Congress Ethics Round Table II: Withholding or withdrawing of treatment in elderly patients admitted to the intensive care unit.
Life-sustaining treatment (LST) limitation for elderly patients is highly controversial. In that context, it is useful to evaluate the attitudes to LST in the elderly among experienced intensive care unit (ICU) physicians with different backgrounds and cultures. ⋯ There is a consensus among ICU physicians that age cannot be the sole criterion on which health care decisions should be made. In that perspective, it is important to provide data showing that outcome differences between elderly and nonelderly patients are partly related to decisions to forgo LSTs.