Journal of critical care
-
Journal of critical care · Oct 2013
Hypophosphatemia on the intensive care unit: Individualized phosphate replacement based on serum levels and distribution volume.
Hypophosphatemia occurs in about 25% of patients admitted to the intensive care unit. To date, a safe and validated phosphate replacement protocol is not available. ⋯ This study shows that phosphate replacement with dose calculation based on serum phosphate levels and a Vd of 0.5 L/kg is effective and safe.
-
Journal of critical care · Oct 2013
Measuring safety culture in Palestinian neonatal intensive care units using the Safety Attitudes Questionnaire.
This study aimed to measure safety culture, examine variations among neonatal intensive care units (NICUs), and assess the associations with caregiver characteristics. ⋯ We found large variations in safety culture within and between a comprehensive sample of Palestinian NICUs. The findings suggest the need for a customized approach that builds on existing strengths and targets areas of opportunities for improvement to optimize health care delivery to the most vulnerable of patients, sick newborns in the NICU setting.
-
Journal of critical care · Oct 2013
High glucose variability increases cerebral infarction in patients with spontaneous subarachnoid hemorrhage.
High glucose variability is a significant marker for poor outcome in critically ill patients. We evaluated the impact of high glucose variability on cerebral infarction following spontaneous subarachnoid hemorrhage (SAH). ⋯ Glucose variability is a significant predictor of cerebral infarction in patients with severe spontaneous SAH.
-
Journal of critical care · Oct 2013
Continuous multiorgan variability analysis to track severity of organ failure in critically ill patients.
The purpose of this study is to evaluate the utility of using continuous heart rate variability (HRV) and respiratory rate variability (RRV) monitoring for (a) tracking daily organ dysfunction in critically ill patients and (b) identifying patterns of variability changes during onset of shock and resolution of respiratory failure. ⋯ There is an association between reduced HRV and RRV and increasing organ dysfunction in critically ill patients. The significance of observing trends of decreasing HRV (with onset of shock) and increasing RRV (with resolution of respiratory failure) merits further investigation.
-
Journal of critical care · Oct 2013
Effect of acute endotoxemia on analog estimates of mean systemic pressure.
Dynamic estimates of mean systemic pressure based on a Guytonian analog model (Pmsa) appear accurate under baseline conditions but may not remain so during septic shock because blood volume distribution and resistances between arterial and venous beds may change. Thus, we examined the effect of acute endotoxemia on the ability of Pmsa, estimated from steady-state cardiac output, right atrial pressure, and mean arterial pressure, to reflect our previously validated instantaneous venous return measure of mean systemic pressure (Pmsi), derived from beat-to-beat measures of right ventricular stroke volume and right atrial pressure during positive pressure ventilation. We studied 6 splenectomized pentobarbital-anesthetized close chested dogs. ⋯ Cardiac output increased (2628±905 vs 3560±539 mL/min; P<.05) and mean arterial pressure decreased (107±16 vs 56±12 mm Hg; P<.01) during endo. Changes in Pmsi and Pmsa correlated during both control and endo (r2=0.7) with minimal bias by Bland-Altman analysis (mean difference±95% confidence interval, 0.47±5.04 mm Hg). We conclude that changes in Pmsa accurately tracts Pmsi under both control and endo.