Journal of critical care
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Journal of critical care · Sep 2008
Ciprofloxacin pharmacokinetics in critically ill patients: a prospective cohort study.
Optimal dosing of antibiotics is important for efficacy and avoidance of resistance. Fluoroquinolones are frequently used to treat severe infections in critically ill patients. We studied ciprofloxacin pharmacokinetics after administration of 400 mg twice a day (bid) intravenously (IV). ⋯ Ciprofloxacin 400 mg bid IV leads to inadequate AUC/MIC and C(max)/MIC ratios in many cases. Effective killing concentrations were only achieved in pathogens with MIC less than 0.25. As bacteria in intensive care unit patients often exceed this threshold, we recommend to use higher doses of ciprofloxacin (1200 mg daily) to ensure optimal bacterial killing and avoid antibiotic resistance.
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Journal of critical care · Sep 2008
Safety of percutaneous dilational tracheostomy in hematopoietic stem cell transplantation recipients requiring long-term mechanical ventilation.
Recent reports have shown that the outcome of mechanically ventilated patients after hematopoietic stem cell transplantation (HSCT) has improved. This study was conducted to clarify if percutaneous dilational tracheostomy is safe in this group of patients and to report the outcome of HSCT recipients requiring long-term mechanical ventilation. ⋯ Percutaneous dilational tracheostomy can be safely performed on patients with acute respiratory failure after HSCT. This procedure did not result in postoperative wound infections or significant bleeding complications. Furthermore, the results of our study indicate that today even patients with prolonged mechanical ventilation (>20 days) have a chance of long-term survival.
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Journal of critical care · Sep 2008
Reduced heart rate multiscale entropy predicts death in critical illness: a study of physiologic complexity in 285 trauma patients.
We have shown previously that reduced integer heart rate variability (HRVi) predicts death in trauma patients. We hypothesized that heart rate multiscale entropy (MSE), a potential measurement of physiologic complexity, would predict death more robustly than HRVi. ⋯ Multiscale entropy and HRVi measured within the first 24 hours each identify trauma patients at increased risk of subsequent hospital death.
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Journal of critical care · Sep 2008
Risk factors for the development of early-onset delirium and the subsequent clinical outcome in mechanically ventilated patients.
The aim of the study was to investigate the risk factors of developing early-onset delirium in mechanically ventilated patients and determine the subsequent clinical outcomes. ⋯ Mechanically ventilated patients with sepsis or hypoalbuminemia were more vulnerable to develop delirium in their early stay in the ICU. Early-onset delirium is associated with prolonged duration of mechanical ventilation and higher incidence of nosocomial pneumonia, leading to a higher mortality.