Journal of critical care
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Journal of critical care · Oct 2012
Impact of pattern of admission on outcomes after aneurysmal subarachnoid hemorrhage.
Patients with aneurysmal subarachnoid hemorrhage (aSAH) require management in centers with neurosurgical expertise necessitating emergent interhospital transfer (IHT). Our objective was to compare outcomes in aSAH IHTs to our institution with aSAH admissions from our institutional emergency department (ED). ⋯ Our institutional ED SAH admissions had significantly better outcomes than did IHTs, suggesting that delays in optimizing care before transfer could deleteriously impact outcomes.
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Journal of critical care · Oct 2012
Hypophosphatemia and its clinical implications in critically ill children: a retrospective study.
The aims of this study were to determine the prevalence of hypophosphatemia and to discuss the clinical implications of hypophosphatemia in critically ill children. ⋯ Critically ill pediatric patients are prone to hypophosphatemia, especially if they cannot be fed early by enteral route. Hypophosphatemia is associated with an increased duration of mechanical ventilation and increased length of stay in the pediatric intensive care unit, suggesting that active repletion might improve these parameters.
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Journal of critical care · Oct 2012
A method for estimation of plasma albumin concentration from the buffering properties of whole blood.
Hypoalbuminemia is strongly associated with poor clinical outcome. Albumin is usually measured at the central laboratory rather than point of care, but in principle, information exists in the buffering properties of whole blood to estimate plasma albumin concentration from point of care measurements of acid-base and oxygenation status. This article presents and evaluates a new method for doing so. ⋯ This new method may be a valuable tool in screening and monitoring plasma albumin concentration in acutely ill patients, from measurements taken at the point of care.
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Journal of critical care · Oct 2012
Central line placement in patients with and without prophylactic plasma.
Central line placement (CLP) is a common life-saving intervention in critically ill patients, and patients with coagulation abnormalities as identified by an abnormal international normalized ratio (INR) may receive prophylactic plasma transfusion before the procedure despite previously published data that such a practice is not efficacious. Over a 14-month period, 287 CLPs were performed in the intensive care unit. ⋯ Only 1 case of bleeding was observed in a patient with an INR of 3.9, who received fresh frozen plasma preprocedure (0/73 vs 1/27; P = .6). The occurrence of bleeding was very low overall with CLP (0.3%; 95% confidence interval, 0%-2%), and no benefit of prophylactic plasma was observed.
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Journal of critical care · Oct 2012
ReviewNoise in hospital intensive care units--a critical review of a critical topic.
The aims of the study were to examine the studies related to hospital noise in intensive care units (ICUs) to understand the sources and effects of noise and to describe best practices and common problems in the varying methods commonly applied to reduce the noise level. ⋯ Significant opportunities exist to improve methodologies to study noise levels to reduce noise in hospital ICUs. Many previous studies have used inconsistent methodologies with poorly defined parameters that make it difficult to compare results. Our work points out common pitfalls in the recording and sharing of hospital acoustic parameters and also points to the paucity of important economic considerations in extant studies. These results can be helpful for future research in this area. Many past salutary interventions--including educational noise reduction programs, behavioral modification using sound detection equipment, and low- as well as high-cost environmental alterations--do not generally appear to be adequate to minimize noise to levels for hospital rooms specified by international agencies. But a potentially important clue for future work involves the finding that as the number of patients and staff of the ICU increases, noise levels appear to also increase.