Critical care medicine
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Critical care medicine · Mar 2006
Weekend and weeknight admissions have the same outcome of weekday admissions to an intensive care unit with onsite intensivist coverage.
Several reports have indicated increased mortality for weekend and nighttime admissions to the intensive care unit. This increase has been attributed to differences in staffing levels. The impact of onsite 24-hr/7-day intensivist staffing on weekend and weeknight outcomes has not been examined before. The objective of this study was to determine whether weekend and nighttime admissions compromise patient outcome in an intensive care unit staffed by an onsite intensivist 24 hrs a day and 7 days a week. ⋯ In an intensive care unit staffed by onsite certified intensivists 24 hrs/7 days, we found no compromise in the care of patients admitted during weekends and weeknights. These findings suggest that such coverage helps in ensuring consistency of care and therefore represents a potentially improved model for intensive care unit practice.
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Critical care medicine · Mar 2006
Review Meta Analysis Comparative StudyMortality predictions in the intensive care unit: comparing physicians with scoring systems.
Risk-prediction models offer potential advantages over physician predictions of outcomes in the intensive care unit (ICU). Our systematic review compared the accuracy of ICU physicians' and scoring system predictions of ICU or hospital mortality of critically ill adults. ⋯ Observational studies suggest that ICU physicians discriminate between survivors and nonsurvivors more accurately than do scoring systems in the first 24 hrs of ICU admission. The overall accuracy of both predictions of patient mortality was moderate, implying limited usefulness of outcome prediction in the first 24 hrs for clinical decision making.
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Critical care medicine · Mar 2006
Randomized Controlled Trial Multicenter StudyL-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study.
Glutamine (Gln)-supplemented total parenteral nutrition (TPN) improves clinical outcome after planned surgery, but the benefits of Gln-TPN for critically ill (intensive care unit; ICU) patients are still debated. ⋯ TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance.
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Critical care medicine · Mar 2006
Multicenter Study Comparative StudyA multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria.
To validate scoring algorithm criteria established by the Japanese Association for Acute Medicine (JAAM) for disseminated intravascular coagulation (DIC) and to evaluate its diagnostic property by comparing the two leading scoring systems for DIC, from the Japanese Ministry of Health and Welfare (JMHW) and International Society on Thrombosis and Haemostasis (ISTH). ⋯ The JAAM scoring system has an acceptable property for the diagnosis of DIC. The scoring system identified most of the patients diagnosed by the JMHW and ISTH criteria. Revised JAAM DIC criteria preserved all properties of the original criteria for DIC diagnosis. The revised scoring system can be useful for selecting DIC patients for early treatment in a critical care setting.
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Critical care medicine · Mar 2006
Multicenter StudyDoes dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study.
The optimal adrenergic support in shock is controversial. We investigated whether dopamine administration influences the outcome from shock. ⋯ This observational study suggests that dopamine administration may be associated with increased mortality rates in shock. There is a need for a prospective study comparing dopamine with other catecholamines in the management of circulatory shock.