Journal of critical care
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Journal of critical care · Jun 2012
Comparative StudyComparison of cumulative incidence analysis and Kaplan-Meier for analysis of shock reversal in patients with septic shock.
Kaplan-Meier (KM) has become the most used method to evaluate time-to-event analysis, although it is unsuitable in competing event situations such as death and shock reversal. Despite that the use of this methodology is not widely disseminated, cumulative incidence analysis (CIA) is more appropriate in these situations. We used CIA and KM (with 2 different techniques of censoring) to compare shock reversal in a cohort of patients with septic shock after steroid therapy. Furthermore, we have analyzed shock reversal in responders and nonresponders to high-dose cortrosyn test (250 μg). ⋯ Kaplan-Meier overestimates shock reversal. Cumulative incidence analysis seems to be a more appropriate method to analyze shock reversal. Future trials intended to analyze shock reversal should apply CIA.
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Journal of critical care · Jun 2012
Evolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A clinical-physiologic study.
Perfusion assessment during septic shock resuscitation is difficult and usually complex determinations. Capillary refill time (CRT) and central-to-toe temperature difference (Tc-toe) have been proposed as objective reproducible parameters to evaluate peripheral perfusion. The comparative evolution of peripheral vs metabolic perfusion parameters in septic shock resuscitation has not been studied. We conducted a prospective observational clinical-physiologic study to address this subject. ⋯ Early recovery of peripheral perfusion anticipates a successful resuscitation compared with traditional metabolic parameters in septic shock patients. Our findings support the inclusion of serial peripheral perfusion assessment in multimodal monitoring strategies for septic shock resuscitation.
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Journal of critical care · Jun 2012
Adverse events and clinical outcome associated with drotrecogin alfa-activated: a single-center experience of 498 patients over 8 years.
Licensed in 2002 for severe sepsis, drotrecogin alfa-activated (DAA) remains a much debated therapy particularly with respect to outcomes and a potentially increased risk of serious bleeding events (SBEs). Recent publications have suggested a significantly increased incidence of SBEs and death in those with baseline bleeding risks (BBRs). Our center is one of the highest prescribers of DAA worldwide; we describe our experience of SBEs and other clinical outcomes. ⋯ This large single-center case series demonstrates that DAA has an incidence of SBEs similar to initial clinical trials. As expected, SBEs were associated with a poor outcome.
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Journal of critical care · Jun 2012
Critically ill patients with cancer and sepsis: clinical course and prognostic factors.
The purposes of this study were to evaluate the clinical course and to identify independent predictors of mortality in patients with cancer with sepsis. ⋯ Sepsis remains a frequent complication in patients with cancer and associated with high mortality. Our results can be of help to assist intensivists in clinical decisions and to improve characterization and risk stratification in these patients.
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Journal of critical care · Jun 2012
Heparin-induced thrombocytopenia type II in a surgical intensive care unit.
The aim of this study was to investigate the epidemiology of and outcome from heparin-induced thrombocytopenia type II (HIT) in surgical intensive care unit (ICU) patients. ⋯ In this cohort of surgical ICU patients, HIT was associated with increased morbidity but not mortality rates compared with a nested matched control group. The nadir platelet count was independently associated with a higher risk of in hospital death in these patients.