Journal of critical care
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Journal of critical care · Apr 2014
Observational StudyIncidence and outcome of metabolic disarrangements consistent with citrate accumulation in critically ill patients undergoing continuous venovenous hemodialysis with regional citrate anticoagulation.
Systemic citrate accumulation is a complication of regional citrate anticoagulation (RCA) during continuous renal replacement therapy (CRRT). Our objective was to determine the incidence of clinical signs consistent with citrate accumulation in a large and representative cohort of intensive care unit patients undergoing RCA-CRRT. ⋯ The incidence of disarrangements consistent with citrate accumulation in patients undergoing RCA-continuous venovenous hemodialysis was low, taking place exclusively in patients with severe lactic acidosis due to multiorgan failure. This suggests that the appearance of citrate accumulation is secondary to a severe failure of cellular respiration.
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Journal of critical care · Apr 2014
Evaluating the obtunded patient after cardiac surgery: The role of continuous electroencephalography.
This prospective study was designed to evaluate the role of continuous electroencephalography (EEG) in the management of adult patients with neurological dysfunction early after cardiac surgery. ⋯ Non-convulsive status epilepticus may be an under-recognized cause of obtundation early after cardiac surgery. Continuous EEG monitoring is a non-invasive test that can identify patients that may benefit from anti-epileptic medication. Larger comparative studies are required to establish whether this leads to significant improvements in patient outcomes.
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Journal of critical care · Apr 2014
Anxiety and depression symptoms among families of adult intensive care unit survivors immediately following brief length of stay.
Prior studies of anxiety and depression among families of intensive care unit patients excluded those admitted for less than 2 days. We hypothesized that families of surviving patients with length of stay less than 2 days would have similar prevalence of anxiety and depression compared with those admitted for longer. ⋯ Families of surviving patients with brief length of stay may have similar prevalence of anxiety and depression at discharge to those with longer length of stay.
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Journal of critical care · Apr 2014
Plasma l-citrulline concentrations and its relationship with inflammation at the onset of septic shock: A pilot study.
Hypocitrullinemia has been suggested to be a prognostic factor for patients in intensive care. The aim of this ancillary study of the Corticosteroids and Intensive Insulin Therapy for Septic Shock prospective study was to investigate plasma L-citrulline concentrations and its relationship with inflammation and digestive bacterial translocation in patients with septic shock multiorgan failure and without primary intestinal disease or chronic renal failure. ⋯ At the onset of septic shock, plasma citrulline decreases and varies inversely with C-reactive protein and is lower when digestive bacterial translocation occurs. This finding could reflect an early acute intestinal dysfunction, but measurement of citrulline concentration does not appear to be able to predict the patients' mortality.
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Journal of critical care · Apr 2014
The desirability of an Intensive Care Unit (ICU) Clinician-Led Bereavement Screening and Support Program for Family Members of ICU Decedents (ICU Bereave).
Many bereaved family members (FMs) of intensive care unit decedents experience symptoms of complicated grief (CG) or social distress, but there is no standard screening or follow-up for these individuals. We determined the desirability and need for an intensive care unit-based bereavement screening and support program for these FMs. ⋯ An ICU-based bereavement screening and support program for FMs of ICU decedents is both needed and desirable, although there are important needs and barriers. Future studies should evaluate the effectiveness for such a program at improving outcomes among bereaved FMs.