Journal of critical care
-
Journal of critical care · Jun 2014
Randomized Controlled Trial Multicenter StudyRelative adrenal insufficiency in critically ill patient after rapid sequence intubation: KETASED ancillary study.
Relative adrenal insufficiency (RAI) has been reported as a predictor of mortality in septic patient; however, its effects on mortality and outcomes for critically ill patients remain debatable. The objective of this study was to assess the effect of RAI on prognostic outcomes in patients after out-of-hospital rapid sequence intubation (RSI) and factors associated with the onset of RAI. ⋯ In critically ill patients who require RSI, RAI is common and is not associated with worsened outcomes in our cohort.
-
Journal of critical care · Jun 2014
Influenza A (H1N1) vs non-H1N1 ARDS: Analysis of clinical course.
The purpose of the study is to compare H1N1-induced acute respiratory distress syndrome (ARDS) with ARDS due to other causes of severe community-acquired pneumonia focusing on pulmonary function. ⋯ Clinical course of H1N1-ARDS is substantially different from non-H1N1-ARDS. Affected patients may require extensive therapy including extracorporeal lung support in ARDS referral centers.
-
Journal of critical care · Jun 2014
ReviewImproving patient care through the prism of psychology: Application of Maslow's hierarchy to sedation, delirium, and early mobility in the intensive care unit.
The intensive care unit (ICU) is not only a place where lives are saved; it is also a site of harm and iatrogenic injury for millions of people treated in this setting globally every year. Increasingly, hospitals admit only the sickest patients, and although the overall number of hospital beds remains stable in the United States, the percentage of that total devoted to ICU beds is rising. These 2 realities engender a demographic imperative to address patient safety in the critical care setting. ⋯ Although there is currently much research and quality improvement in this area, most of what we know from these data and published guidelines has not become reality in the day-to-day management of ICU patients. This article is not intended to provide a comprehensive review of the literature but rather a framework to rethink our currently outdated culture of critical care by employing Maslow's hierarchy of needs, along with a few novel analogies. Application of Maslow's hierarchy will help propel health care professionals toward comprehensive care of the whole person not merely for survival but toward restoration of pre-illness function of mind, body, and spirit.
-
Journal of critical care · Jun 2014
ReviewPersistent organ dysfunction after severe sepsis: A systematic review.
Sepsis is a prevalent disease with high mortality. Survivors of sepsis often suffer significant resultant morbidity, including organ dysfunction. However, little is known about persistent or long-term organ dysfunction in this patient population. Our objective was to systematically review original research studies evaluating organ-specific outcomes at 28 days or greater in patients surviving severe sepsis. ⋯ Our review found variable rates of organ dysfunction at 1 month after severe sepsis. Future studies should attempt to characterize organ dysfunction at greater than 1 month after an acute severe sepsis episode to determine the true prevalence long-term organ dysfunction and treatments for prevention. Additionally, standardized objective measures of organ dysfunction are needed so that future studies can be directly compared.
-
Journal of critical care · Jun 2014
ReviewPrognosis of emergency department patients with suspected infection and intermediate lactate levels: A systematic review.
Previous studies have shown a correlation between blood lactate greater than 4.0 mmol/L and mortality in patients with suspected infection in the emergency department (ED), but data are more limited regarding the prognosis of intermediate blood lactate (2.0-3.9 mmol/L), particularly in the absence of hemodynamic instability. We sought to quantify the prognostic significance of intermediate blood lactate levels in ED patients with suspected infection, emphasizing patients without hypotension. ⋯ This systematic review found that among ED patients with suspected infection, intermediate lactate elevation is associated with a moderate to high risk of mortality, even among patients without hypotension. Physicians should consider close monitoring and aggressive treatment for such patients.