Journal of critical care
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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
The sensitivity and specificity of ultrasound estimation of central venous pressure using the internal jugular vein.
The fluid volume status of a patient is difficult to assess clinically. The aim of this study was to compare the ultrasound estimation of the height of the right internal jugular vein (CVP(IJV)) with direct estimation of central venous pressure (CVP) (CVP(CVC)). ⋯ Ultrasound estimation of CVP using a portable ultrasound machine and the internal jugular vein is simple, noninvasive, and accurate.
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Journal of critical care · Jun 2012
Multicenter StudyRisk factors for underuse of lung-protective ventilation in acute lung injury.
We assessed factors associated with underuse of lung-protective ventilation (LPV) in patients with acute lung injury (ALI). ⋯ Simple interventions could substantially improve adherence with LPV among patients with ALI and warrant prospective study.
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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.
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Journal of critical care · Jun 2012
Diagnostic value of positron emission tomography combined with computed tomography for evaluating patients with septic shock of unknown origin.
(18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with computed tomography (CT) is a promising new tool for the identification of infectious foci. The aim of our work was to evaluate the diagnostic value of FDG-PET/CT in critically ill patients with septic shock of unknown origin. ⋯ The FDG-PET/CT is a valuable tool for the localization of infectious foci in critically ill patients with severe sepsis/septic shock in whom conventional diagnostic methods fail to detect these foci. Prospective studies with more patients are warranted to further evaluate the diagnostic accuracy and feasibility of this diagnostic tool in critically ill patients with severe sepsis.