Journal of critical care
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Journal of critical care · Dec 2012
Use of mechanical ventilation protocols in intensive care units: a survey of current practice.
Mechanical ventilation protocols for treating intensive care unit (ICU) patients are often recommended to improve process of care and outcomes, but their composition may be variable and penetration into clinical practice may be incomplete. We sought to ascertain ICU and hospital characteristics associated with adoption of mechanical ventilation (MV) protocols in Ontario, Canada. ⋯ Most surveyed hospitals reported the presence of a protocol for MV, but only half of these incorporated low tidal volume ventilation. Several organizational factors were associated with adoption of protocols, and therefore, these should also be considered when evaluating the impact of protocols on clinical outcomes.
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Journal of critical care · Dec 2012
Clinical TrialImpact of red blood cells transfusion on ICU-acquired bloodstream infections: a case-control study.
Our study investigated the impact of packed red blood cell (pRBC) transfusion on the occurrence of bloodstream infections (BSIs) in patients admitted in a multidisciplinary intensive care unit (ICU), further assessing potential associations with particular BSI types. A nested matched (1:1) case-control design was implemented. Sex, age, admission category, Acute Physiology and Chronic Health Evaluation score II (plus Injury Severity Score in trauma patients) were used for matching. ⋯ In multivariable analysis, pRBC transfusion was independently associated with 2-fold probability for BSI (adjusting for matching variables and propensity score). There was a significant dose-dependent association of BSI risk with regard to the number of pRBC units transfused (odds ratios [OR], 1.73, 2.09, 2.34 for 1-3, 4-6, and more than 6 pRBC units transfused, respectively, compared with nontransfused patients, P values .116, .018, and .015, respectively). In subgroup analysis, catheter-related BSIs displayed the strongest association with pRBC transfusion (OR = 5.01, P = .014).
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Journal of critical care · Dec 2012
The effects of hemodialysis on blood glutamate levels in chronic renal failure: implementation for neuroprotection.
The purpose of the present study is to investigate whether hemodialysis (HD) is effective in lowering blood glutamate levels. In addition, we examined the effect of HD on glutamate oxaloacetate transaminase (GOT) and glutamate pyruvate transaminase (GPT) levels in the blood and described the rate and pattern of blood glutamate clearance during HD. ⋯ Hemodialysis may be a promising method of reducing blood glutamate levels.
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Journal of critical care · Dec 2012
Comparative StudyBias reduction in repeated-measures observational studies by the use of propensity score: the case of enteral sedation for critically ill patients.
Within the evidence-based medicine paradigm, randomized controlled trials represent the "gold standard" to produce reliable evidence. Indeed, planning and implementing randomized controlled trials in critical care medicine presents limitations because of intrinsic and structural problems. As a consequence, observational studies still occur frequently. In these cases, propensity score (PS) (probability of receiving a treatment conditional on observed covariates) is an increasingly used technique to adjust the results. Few studies addressed the specific issue of a PS correction of repeated-measures designs. ⋯ Propensity score represents a useful additional tool to estimate the effects of treatments in nonrandomized studies. In the case study, an enteral sedation approach was equally effective to an intravenous regime, allowing for a lower level of sedation and spare of resources.
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Journal of critical care · Dec 2012
Prediction of extubation failure in medical intensive care unit patients.
The purpose of this study was to evaluate prediction factors for extubation failure (need for reintubation within 48 hours) in medical intensive care unit patients. ⋯ Low preextubation serum anion gap values and low preextubation Pao(2)/Fio(2) ratio might help to predict extubation failure in medical intensive care unit patients.