Journal of critical care
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Journal of critical care · Aug 2012
Extravascular lung water indexed or not to predicted body weight is a predictor of mortality in septic shock patients.
The purpose was to investigate whether extravascular lung water (EVLW) indexed to actual body weight (EVLWa) is an independent predictor of mortality in patients with septic shock, to determine the relationship between EVLWa and other markers of lung injury, and to test if indexing EVLW with predicted body weight (EVLWp) strengthens its predictive power. ⋯ Extravascular lung water indexed or not to predicted body weight is an independent predictor of mortality in patients with septic shock. Repeated measurements of EVLW indexes over time, rather than a too-early measurement, seem to be more appropriate for predicting outcome.
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Journal of critical care · Aug 2012
Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the Modified Early Warning Score.
Clear and detectable signs of deterioration have been shown to be present in many patients multiple hours before undergoing a serious life-threatening event. To date, few studies are available describing normal practice and the possible effectiveness of structured tools regarding recognition of deteriorating patients. The aim of this study was to describe the current practice in measurement and documentation of vital signs and the possible usefulness of the Modified Early Warning Score (MEWS) to identify deteriorating patients on hospital wards. ⋯ Two hundred four patients were included. In the 48 hours before the event, a total of 2688 measurements of one or more vital signs were taken. Overall, 81% of the patients had an MEWS value of 3 or more at least once during the 48 hours before their event. Recordings of vital signs were mostly incomplete. Even when the MEWS was 3 or more, respiratory rate, diuresis, and oxygen saturation were documented in only 30% to 66% of assessments.
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Journal of critical care · Aug 2012
The effect of body position changes on stroke volume variation in 66 mechanically ventilated patients with sepsis.
The aim of the study was to investigate the effect of body position changes on the stroke volume (SI) variation (SVV) in ventilated patients with sepsis. ⋯ Body position changes may affect the correlation of SVV with hemodynamic variables. The 30° head-up and prone positions increased SVV because of the associated decreased SV. The 30° left or right recumbent position does not affect SVV and SV.
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Journal of critical care · Aug 2012
Comparative StudyComparison of 3 different methods used to measure the rapid shallow breathing index.
Rapid shallow breathing index (RSBI) is conveniently measured through the ventilator. If continuous positive airway pressure (CPAP) is used, it may change the RSBI value. We measured the RSBI with a handheld spirometer and through the ventilator, with and without CPAP, to assess differences. ⋯ The RSBI values measured through the ventilator with CPAP 5 cm H(2)O are much lower than the values measured with a handheld spirometer. Even the RSBI values measured with CPAP 0 cm H(2)O are significantly lower. This is attributable to the base flow delivered by some ventilators. The difference must be taken into account during weaning assessment.
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Journal of critical care · Aug 2012
Comparative StudyEffect of 24-hour mandatory vs on-demand critical care specialist presence on long-term survival and quality of life of critically ill patients in the intensive care unit of a teaching hospital.
Mandatory compared with on-demand intensivist presence improves processes of care and decreases intensive care unit (ICU) complication rate and hospital length of stay. The effect of continuous mandatory intensivist coverage on long-term patient mortality and quality of life (QOL) is not known. ⋯ Introduction of an additional night shift to provide mandatory as opposed to on-demand 24-hour staff critical care specialist coverage did not affect long-term survival of medical ICU patients.