Journal of critical care
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Journal of critical care · Jun 2010
Comparative StudyThe 4Ts scoring system for heparin-induced thrombocytopenia in medical-surgical intensive care unit patients.
Heparin-induced thrombocytopenia (HIT) is commonly considered but rarely confirmed in critically ill patients. The 4Ts score (Thrombocytopenia, Timing of thrombocytopenia, Thrombosis, and oTher reason) might identify individual patients at risk of having this disorder. ⋯ Significant thrombocytopenia during heparin administration occurred in 9.5% of critically ill patients, but HIT was confirmed in only 4.1% of those undergoing testing, for an overall incidence of 0.4%. A low 4Ts score occurred in 78% of patients investigated for HIT; none of these patients had a positive SRA. We conclude that HIT is uncommon in critically ill patients and that the 4Ts score is worthy of further evaluation in this patient population.
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Journal of critical care · Jun 2010
Mortality reduction after implementing a clinical practice guidelines-based management protocol for severe traumatic brain injury.
The objective of this study was to examine the effect of implementing a clinical practice guidelines-based management protocol on the outcome of patients with severe traumatic brain injury (TBI). ⋯ The protocol implementation was associated with a reduction in hospital and ICU mortality. This improvement was not associated with an increase in the frequency of tracheostomies and in ICU or hospital LOS, suggesting that the improved survival was not associated with the increased number of surviving patients with severe disability and that the functional status might have also improved.
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Journal of critical care · Jun 2010
Outcome of patients with injection drug use-associated endocarditis admitted to an intensive care unit.
The purpose of this study was to study the outcome of patients with injection drug use-associated infective endocarditis (IDU-IE) admitted to an intensive care unit (ICU). ⋯ Complicated IDU-IE necessitating admission to ICU is associated with high mortality. In addition to consequences of sepsis, septic embolization to central nervous system and lungs contributes to development of organ failure. Increased severity of illness and prior history of endocarditis are associated with poor outcome.
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Journal of critical care · Jun 2010
Soluble triggering receptor expressed on myeloid cells 1 and the diagnosis of sepsis.
Early diagnosis and assessment of the systemic inflammatory response to infection are difficult with usual markers (fever, leukocytosis, C-reactive protein [CRP]). Triggering receptor expressed on myeloid cells-1 (TREM-1) expression on phagocytes is up-regulated by microbial products. We studied the ability of soluble TREM-1 (sTREM-1) to identify patients with sepsis. ⋯ C-reactive protein and ESR performed better than sTREM-1 and white blood cell count in diagnosing infection.
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Journal of critical care · Jun 2010
Practice variability in the assessment and treatment of critical illness-related corticosteroid insufficiency.
Little is known about how published evidence regarding use of steroids in septic shock has been incorporated into clinical practice. ⋯ Treatment and evaluation of critical illness-related corticosteroid insufficiency in critically ill patients at our institution are inconsistent. Many patients with VDSS do not receive either treatment or evaluation for critical illness-related corticosteroid insufficiency, and patients who do not meet the current criteria are being evaluated and/or treated for critical illness-related corticosteroid insufficiency.