Critical care medicine
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Critical care medicine · Dec 2009
Multicenter StudyHyperglycemia-related mortality in critically ill patients varies with admission diagnosis.
Hyperglycemia during critical illness is common and is associated with increased mortality. Intensive insulin therapy has improved outcomes in some, but not all, intervention trials. It is unclear whether the benefits of treatment differ among specific patient populations. The purpose of the study was to determine the association between hyperglycemia and risk- adjusted mortality in critically ill patients and in separate groups stratified by admission diagnosis. A secondary purpose was to determine whether mortality risk from hyperglycemia varies with intensive care unit type, length of stay, or diagnosed diabetes. ⋯ The association between hyperglycemia and mortality implicates hyperglycemia as a potentially harmful and correctable abnormality in critically ill patients. The finding that hyperglycemia-related risk varied with admission diagnosis suggests differences in the interaction between specific medical conditions and injury from hyperglycemia. The design and interpretation of future trials should consider the primary disease states of patients and the balance of medical conditions in the intensive care unit studied.
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Critical care medicine · Dec 2009
Multicenter StudyPotential clinical utility of polymerase chain reaction in microbiological testing for sepsis.
To evaluate the potential improvement of antimicrobial treatment by utilizing a new multiplex polymerase chain reaction (PCR) assay that identifies sepsis-relevant microorganisms in blood. ⋯ Rapid PCR identification of microorganisms may contribute to a reduction of early inadequate antibiotic treatment in sepsis.
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Critical care medicine · Dec 2009
Multicenter StudyPresence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality.
To assess whether the presence and severity of intensive care unit-acquired paresis are associated with intensive care unit and in-hospital mortality. ⋯ Both the presence and severity of intensive care unit-acquired paresis at the time of awakening are associated with increased intensive care unit and hospital mortality; the mechanisms underlying this association need further study.
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Critical care medicine · Dec 2009
Multicenter Study Comparative StudyLong-term survival in older critically ill patients with acute ischemic stroke.
To compare survival in older patients with acute ischemic stroke admitted to intensive care units (ICUs) with those not requiring ICU care and to assess the impact of mechanical ventilation (MV) and percutaneous gastrostomy tubes (PEG) on long-term mortality. ⋯ Both short-term and long-term mortality in older patients with acute ischemic stroke admitted to ICUs is lower than previously reported. The need for MV and PEG are markers for poor long-term outcome. Future research should focus on the identification of clinical factors that lead to increased mortality in long-term survivors and efforts to reduce those risks.
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Critical care medicine · Dec 2009
Multicenter StudyUse of intravenous infusion sedation among mechanically ventilated patients in the United States.
Many studies compare the efficacy of different forms of intravenous infusion sedation for critically ill patients, but little is known about the actual use of these medications. We sought to describe current use of intravenous infusion sedation in mechanically ventilated patients in U.S. intensive care units. ⋯ The percentage of mechanically ventilated patients receiving intravenous infusion sedation has increased over time. Sedation with an infusion of propofol was much more common than with benzodiazepines or dexmedetomidine, even for patients mechanically ventilated beyond 96 hrs.