Journal of critical care
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Journal of critical care · Aug 2014
ReviewObesity and perioperative acute kidney injury: A focused review.
Obesity has reached epidemic proportions in the developed world today. Obesity is a significant risk factor for cardiovascular disease, hypertension, diabetes mellitus, and chronic kidney disease. There has been renewed interest in the role of perioperative renal dysfunction with the establishment of new diagnostic criteria for kidney dysfunction such as the Acute Kidney Injury Network criteria and the Risk-Injury-Failure-Loss End-stage kidney disease criteria. ⋯ Furthermore, the traditional methods of quantifying obesity such as body mass index are increasing being questioned because they may not accurately reflect true visceral obesity and may skew epidemiologic classification of metabolically healthy patients. Recent epidemiologic studies suggest the existence of an obesity paradox wherein obese patients seem to have superior perioperative outcomes compared with patients with normal and low body mass index. We seek to review the epidemiologic and pathophysiologic aspects of obesity, especially with respect to structural and functional changes in kidney function and their impact on perioperative outcomes.
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Journal of critical care · Aug 2014
Multicenter Study Observational StudyA multicenter population-based effectiveness study of teleintensive care unit-directed ventilator rounds demonstrating improved adherence to a protective lung strategy, decreased ventilator duration, and decreased intensive care unit mortality.
The purpose of the study is to determine if teleintensive care unit (ICU)-directed daily ventilator rounds improved adherence to lung protective ventilation (LPV), reduced ventilator duration ratio (VDR), and ICU mortality ratios. ⋯ Implementation of teleICU-directed ventilator rounds was associated with improved and durable adherence to LPV and significant reductions in both VDR and ICU mortality.
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Journal of critical care · Aug 2014
The cost-effectiveness ratio of a managed protocol for severe sepsis.
Severe sepsis is a time-dependent disease, and implementation of early treatment has been associated with mortality rate reduction. However, the literature is controversial regarding cost-effectiveness analysis of this intervention. The aim was to assess the cost-effectiveness of a managed protocol for the treatment of severe sepsis. ⋯ Given that the incremental cost was lower than or equal to zero, the effectiveness of the protocol was justified by the significant increase in the life-years saved and the reduced mortality.
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Journal of critical care · Aug 2014
Women are more than twice as likely to die from burns as men in Australia and New Zealand: An unexpected finding of the Burns Evaluation And Mortality (BEAM) Study.
While the risk of death after nonthermal trauma and sepsis may be higher for men, sex differences in outcome after burns are inconsistently reported. The Burns Evaluation And Mortality Study examined the outcomes of all patients admitted after thermal injury to the intensive care unit (ICU) at 8 of 9 burn referral centers in Australia and New Zealand between January 1, 2005, and December 31, 2011. There were 348 women and 1367 men treated for acute burns. ⋯ After adjusting for confounding factors, women had more than double the risk of death compared with men (odds ratio, 2.35; 95% confidence interval, 1.38-4.01; P=.002). Our study conclusively shows worse outcomes for women with burns admitted to ICUs in Australia and New Zealand. Further research is required to determine why this is happening.
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Journal of critical care · Aug 2014
Antiphospholipid antibodies in critically ill patients with cancer: A prospective cohort study.
The purpose of this study is to evaluate the prevalence and the prognostic impact of antiphospholipid antibodies (aPL) in critically ill cancer patients. ⋯ Lupus anticoagulants were frequent in critically ill cancer patients. However, they were not associated with medium-term survival in these patients.