Critical care medicine
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Critical care medicine · Nov 2009
Multicenter Study Meta Analysis Comparative StudyAssociation between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia.
To compare the 28-day mortality and hospital length of stay of patients with community-acquired pneumonia who were transferred to an intensive care unit on the same day of emergency department presentation (direct-transfer patients) with those subsequently transferred within 3 days of presentation (delayed-transfer patients). ⋯ Our findings suggest that some patients without major criteria for severe community-acquired pneumonia, according to the recent Infectious Diseases Society of America/American Thoracic Society consensus guideline, may benefit from direct transfer to the intensive care unit. Further studies are needed to prospectively identify patients who may benefit from direct intensive care unit admission despite a lack of major severity criteria for community-acquired pneumonia based on the current guidelines.
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Critical care medicine · Nov 2009
Immortal time bias in critical care research: application of time-varying Cox regression for observational cohort studies.
To examine the bias introduced by using time-fixed methodology to analyze the effects of a time-varying exposure incurred in the intensive care unit. ⋯ Studies using a time-fixed analytic approach to understand relationships between exposures and clinical outcomes can result in considerable bias when the variables overlap temporally in occurrence. Those conducting such studies, and clinicians reading them, should ensure that time-varying exposures are correctly analyzed to avoid biased conclusions.
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Critical care medicine · Nov 2009
Randomized Controlled Trial Multicenter StudyEfficacy and safety of a phospholipid emulsion (GR270773) in Gram-negative severe sepsis: results of a phase II multicenter, randomized, placebo-controlled, dose-finding clinical trial.
To assess the survival benefit and safety profile of low-dose (850 mg/kg) and high-dose (1350 mg/kg) phospholipid emulsion vs. placebo administered as a continuous 3-day infusion in patients with confirmed or suspected Gram-negative severe sepsis. Preclinical and ex vivo studies show that lipoproteins bind and neutralize endotoxin, and experimental animal studies demonstrate protection from septic death when lipoproteins are administered. Endotoxin neutralization correlates with the amount of phospholipid in the lipoprotein particles. ⋯ Treatment with phospholipid emulsion did not reduce 28-day all-cause mortality, or reduce the onset of new organ failure in patients with suspected or confirmed Gram-negative severe sepsis.
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Critical care medicine · Nov 2009
Multicenter StudySignificance of arterial hypotension after resuscitation from cardiac arrest.
Expert guidelines advocate hemodynamic optimization after return of spontaneous circulation (ROSC) from cardiac arrest despite a lack of empirical data on prevalence of post-ROSC hemodynamic abnormalities and their relationship with outcome. Our objective was to determine whether post-ROSC arterial hypotension predicts outcome among postcardiac arrest patients who survive to intensive care unit admission. ⋯ Half of postcardiac arrest patients who survive to intensive care unit admission die in the hospital. Post-ROSC hypotension is common, is a predictor of in-hospital death, and is associated with diminished functional status among survivors. These associations indicate that arterial hypotension after ROSC may represent a potentially treatable target to improve outcomes from cardiac arrest.
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Critical care medicine · Nov 2009
Multicenter StudySelection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: An observational, multicenter, prospective study.
To describe intensive care unit referral decisions by emergency room physicians in patients aged > or =80 yrs. ⋯ Emergency and intensive care unit physicians were extremely reluctant to consider intensive care unit admission of patients aged > or =80 yrs, despite the presence of criteria indicating that intensive care unit admission was certainly or possibly appropriate.