Journal of critical care
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Journal of critical care · Feb 2013
Comparative StudyComparison of high- and low-dose corticosteroid regimens for organ donor management.
Corticosteroids are used to promote hemodynamic stability and reduce inflammatory organ injury after brain death. High-dose (HD) methylprednisolone has become the standard regimen based on comparisons to untreated/historical controls. However, this protocol may exacerbate hyperglycemia. Our objective was to compare a lower-dose (LD) steroid protocol (adequate for hemodynamic stabilization in adrenal insufficiency and sepsis) to the traditional HD regimen in the management of brain-dead organ donors. ⋯ A lower-dose corticosteroid protocol did not result in worsened donor pulmonary or cardiac function, with comparable organs transplanted compared with the traditional HD regimen. Insulin requirements and glycemic control were improved. High-dose methylprednisolone may not be required to support brain-dead donors.
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Journal of critical care · Feb 2013
Attributable costs of patients with candidemia and potential implications of polymerase chain reaction-based pathogen detection on antifungal therapy in patients with sepsis.
The purposes of this study were to calculate attributable costs of candidemia in patients with severe sepsis and to obtain preliminary data regarding the potential effects of polymerase chain reaction-based pathogen detection on antifungal therapy for these patients. ⋯ Candidemia increases costs of care in patients with septic shock. Polymerase chain reaction-based pathogen detection significantly reduces the time to initiation of antifungal therapy. This might impact on the clinical course of the disease but need to be confirmed in further trials.
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Journal of critical care · Feb 2013
Parental satisfaction, involvement, and presence after pediatric intensive care unit admission.
To describe satisfaction, involvement, presence, and preferences of parents following their child's admission to an intensive care unit (ICU). ⋯ Overall, parental satisfaction ratings were high, lower in parents of children receiving more ICU therapies, and not associated with presence during resuscitation. These data contrast the American Heart Association's recommendation and suggestion of benefit from parental presence during periods of intensive therapies.
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Journal of critical care · Feb 2013
Multicenter StudySafety climate in 5 intensive care units: a nationwide hospital survey using the Greek-Cypriot version of the safety attitudes questionnaire.
Patient safety is considered an antecedent of quality of hospital care. The explicit need to focus on quality of care underpins the aim of the study to evaluate the safety culture and teamwork climate in the public intensive care units (ICUs) of the 5 regional public hospitals in Cyprus as measured by a validated safety attitudes tool. ⋯ Considerable safety climate variations between the ICUs of the regional hospitals of Cyprus have been verified. Age, infrastructure, the severity of cases, and the nurse skill mix are variables that affect the patient safety culture in an ICU environment.
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Journal of critical care · Feb 2013
Muscle strength assessment in critically ill patients with handheld dynamometry: an investigation of reliability, minimal detectable change, and time to peak force generation.
Dynamometry is an objective tool for volitional strength evaluation that may overcome the limited sensitivity of the Medical Research Council scale for manual muscle tests, particularly at grades 4 and 5. The primary aims of this study were to investigate the reliability, minimal detectable change, and time to peak muscle force, measured with portable dynamometry, in critically ill patients. ⋯ Dynamometry can provide reliable measurements in alert critically ill patients, but moderate changes in strength may be required to overcome measurement error, during the acute recovery period. Deficits in force timing may reflect impaired neuromuscular control.