Journal of critical care
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Journal of critical care · Oct 2012
Association of platelet counts decline and mortality in severely burnt patients.
Although the dramatic fluctuation of platelet counts (PCs) has always been observed in severely burnt patients, the underlying relationship between the decline of PCs and mortality has never been well defined. In this study, we evaluated the prognostic implications of PC decline in severely burnt patients. We performed a 3-year retrospective chart of adult patients with a burn index of 50 or greater admitted to 2 burn centers. ⋯ Furthermore, an optimal cutoff of PPC during the first 3 days, which discriminated survivors with nonsurvivors, was 65.53% using the maximum Youden index (0.4853). Although the sensitivity and specificity of PPC during the first 3 days were not as high as the Acute Physiology And Chronic Health Evaluation II score in the present study, Kaplan-Meier estimation and multiple logistic regression models both indicated that a PPC of 65% or greater during the first 3 days was significantly associated with 30-day death (odds ratio, 1.054; 95% confidence interval, 1.006-1.104; P = .028). In summary, an initial slump of PCs, especially a PPC of 65% or greater during the first 3 days, provides prognostic significance for 30-day mortality in severely burnt patients.
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Journal of critical care · Oct 2012
Reliability of the validated clinical diagnosis of pneumonia on validated outcomes after intracranial hemorrhage.
Reducing the incidence of hospital-acquired pneumonia (PNU) is important but depends on accurate assessment. We sought to determine the interrater reliability of diagnosis of PNU and its impact on resource utilization and functional outcomes in a high-risk population. ⋯ Pneumonia had poor interrater reliability despite highly trained reviewers and validated criteria. Although the clinical assessment of PNU is difficult, it was associated with greater resource use and worse outcomes. Diagnosis of clinical PNU may be suboptimal for measuring quality of intensive care.
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Journal of critical care · Oct 2012
Plasma levels of oxidative stress biomarkers and hospital mortality in severe head injury: a multivariate analysis.
The association between biomarkers of oxidative stress and the prognosis of patients with traumatic brain injury (TBI) remains inconclusive. ⋯ Plasma levels of TBARS and carbonyl increase significantly in the first 70 hours after severe TBI but are not independently associated with the hospital mortality.
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Journal of critical care · Oct 2012
Respiratory syncytial virus morbidity, premorbid factors, seasonality, and implications for prophylaxis.
We investigated factors associated with morbidity and pediatric intensive care unit (PICU) admission in children with respiratory syncytial virus (RSV) infection and explored seasonality and implication of prophylaxis. ⋯ Most infants have mild disease and do not require PICU support. Young infants with history of chronic lung disease, congenital heart disease, and neurodevelopmental conditions appear to be at significantly increased risk for PICU support. There is no winter seasonality for RSV disease in Hong Kong. Therefore, any prophylaxis for at-risk population should provide adequate coverage for the warmer months in subtropical regions.
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Journal of critical care · Oct 2012
Use of wireless motility capsule to determine gastric emptying and small intestinal transit times in critically ill trauma patients.
The purpose of this study is to use a novel wireless motility capsule to compare gastric emptying and small bowel transit times in critically ill trauma patients and healthy volunteers. ⋯ Both gastric emptying and small bowel transit were delayed in critically ill trauma patients.