Journal of critical care
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Journal of critical care · Sep 2009
Randomized Controlled Trial Multicenter StudyA randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients.
The objective of this study is to evaluate blood glucose (BG) control efficacy and safety of 3 insulin protocols in medical intensive care unit (MICU) patients. ⋯ The CAIP is safer than and as effective as the standard strict protocol for controlling glucose in MICU patients. Hypoglycemia was rare under conventional treatment. However, BG levels were higher than with IV insulin protocols.
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Journal of critical care · Sep 2009
Meta AnalysisThe efficacy and dosage effect of corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a systematic review.
Atrial fibrillation (AF) complicates up to 60% of patients after cardiac surgery. Current prophylactic measures are inadequate. Corticosteroids down-regulate activation of the proinflammatory response (including C-reactive protein) after cardiopulmonary bypass and have been suggested to reduce the risk of postoperative AF. ⋯ Moderate-dosage corticosteroid (hydrocortisone) should be considered for the prevention of AF in high-risk patients undergoing cardiac surgery. Although the optimal dose, dosing interval, and duration of therapy is unclear, a single dose given at induction may be adequate. The interaction between corticosteroids, beta-blockers, and amiodarone requires further study.
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Journal of critical care · Sep 2009
Multicenter StudyEvaluations of physiologic reactivity and reflexive behaviors during noxious procedures in sedated critically ill patients.
Sedated patients' responses to noxious stimulation are not well characterized. A standardized measure of nociception for use in the intensive care unit (ICU) is elusive. The study aimed to describe cardiovascular and pupil reactivity and behavioral responses between noxious and nonnoxious procedures in sedated ICU patients. ⋯ Certain physiologic reactions and pupil size changes may be potentially useful nociceptive indicators in ICU settings. Further research is needed to determine the clinical parameters of physiologic response change and to evaluate the effects of opioids and sedatives on these physiologic responses.
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Journal of critical care · Sep 2009
Multicenter StudyTime series analysis of use patterns for common invasive technologies in critically ill patients.
Critically ill patients are frequently managed with invasive technologies as part of their medical care. Little is known about use patterns. We examined use trends for invasive technologies used in critically ill patients. ⋯ The use of invasive technologies in critically ill patients is changing and may have important implications for resource use, clinician education, and patient care. Initiatives should be considered for ensuring clinician competency during technology transitions.
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Journal of critical care · Sep 2009
Influence of mild therapeutic hypothermia on the inflammatory response after successful resuscitation from cardiac arrest.
Although animal studies document conflicting data on the influence of hypothermia on cytokine release in various settings, no data exist if hypothermia affects the inflammatory response after successful cardiopulmonary resuscitation. ⋯ In this observational study, hypothermia influenced the inflammatory response after cardiopulmonary resuscitation and lead to a higher rate of bacterial colonization without altering ultimate neurologic recovery.