Journal of critical care
-
Journal of critical care · Mar 2010
Comparative StudyAccuracy of clinical definitions of ventilator-associated pneumonia: comparison with autopsy findings.
We studied patients requiring mechanical ventilation for more than 48 hours who died in the intensive care unit and whose bodies were autopsied. We evaluated 3 clinical definitions of ventilator-associated pneumonia: loose definition, defined as chest radiograph infiltrates and 2 of 3 clinical criteria (leukocytosis, fever, purulent respiratory secretions); rigorous definition, defined as chest radiograph infiltrates and all of the clinical criteria; and a clinical pulmonary infection score higher than 6 points. Sensitivity, specificity, and likelihood ratios were calculated by using pathology pattern as criterion standard. ⋯ Accuracy of 3 commonly used clinical definitions of ventilator-associated pneumonia was poor taking the autopsy findings as reference standard.
-
Journal of critical care · Mar 2010
Elevated blood urea nitrogen is an independent risk factor of prolonged intensive care unit stay due to acute necrotizing pancreatitis.
The aim of this study was to analyze the predictive value of blood urea nitrogen (BUN) and other variables in acute necrotizing pancreatitis on hospital stay, intensive care unit (ICU) stay, and death. ⋯ Although not as reliable as complex clinical scoring systems, BUN as a single marker is a useful routine, easy to perform, and a cheap marker to predict ICU stay and probable survival in acute necrotizing pancreatitis.
-
Journal of critical care · Mar 2010
The impact of the initial ventilatory strategy on survival in hematological patients with acute hypoxemic respiratory failure.
The aim of this study was to assess the impact of the 3 types of initial respiratory support (noninvasive positive pressure ventilation vs invasive positive pressure ventilation vs supplemental oxygen only) in hematological patients with acute hypoxemic respiratory failure (ARF). ⋯ Intensive care unit and in-hospital mortality in our population of hematological patients with hypoxemic ARF was determined by severity of illness and not by the type of initial respiratory support.
-
Journal of critical care · Mar 2010
Systemic and bronchoalveolar cytokines as predictors of in-hospital mortality in severe community-acquired pneumonia.
The aim of this study was to determine whether cytokine expression (interleukin [IL]-1beta, IL-6, IL-8, IL-10, and tumor necrosis factor [TNF]-alpha), C-reactive protein, and endotoxins on the first day of intensive care unit (ICU) admission are associated with hospital mortality in severe community-acquired pneumonia (CAP). ⋯ Serum and BAL fluid levels of the studied cytokines on admission may provide valuable prognostic information for patients with severe CAP.
-
Journal of critical care · Mar 2010
Comparative StudyImproving blood sugar control during critical illness: a cohort study.
The aim of this study is to compare blood sugar control and safety profile of nurse-titrated and medically ordered glucose-insulin regimens. ⋯ In a regional ICU, nurse-titrated glycemic control is safe, effective, and results in high compliance with a glucose target range.