Critical care medicine
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Critical care medicine · May 2009
Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation.
Weaning-induced pulmonary edema is a cause of weaning failure in high-risk patients. The diagnosis may require pulmonary artery catheterization to demonstrate increased pulmonary artery occlusion pressure (PAOP) during weaning. Transthoracic echocardiography can estimate left ventricular filling pressures using early (E) and late (A) peak diastolic velocities measured with Doppler transmitral flow, and tissue Doppler imaging of mitral annulus velocities including early (Ea) peak diastolic velocity. We tested the hypothesis that E/A and E/Ea could be used to detect weaning-induced PAOP elevation defined by a PAOP > or =18 mm Hg during a spontaneous breathing trial (SBT). ⋯ At the end of an SBT, the combination of E/A >0.95 and E/Ea >8.5 measured with transthoracic echocardiography allowed an accurate noninvasive detection of weaning-induced PAOP elevation.
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Critical care medicine · May 2009
ReviewDeveloping a team performance framework for the intensive care unit.
There is a growing literature on the relationship between teamwork and patient outcomes in intensive care, providing new insights into the skills required for effective team performance. The purpose of this review is to consolidate the most robust findings from this research into an intensive care unit (ICU) team performance framework. ⋯ Effective teamwork is shown as crucial for providing optimal patient care in the ICU. In particular, team leadership seems vital for guiding the way in which ICU team members interact and coordinate with others.
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Critical care medicine · May 2009
Comparative StudyProspective validation of the intensive care unit admission Mortality Probability Model (MPM0-III).
To validate performance characteristics of the intensive care unit (ICU) admission mortality probability model, version III (MPM0-III) on Project IMPACT data submitted in 2004 and 2005. This data set was external from the MPM0-III developmental and internal validation data collected between 2001 and 2004. ⋯ MPM0-III calibrates on a new population of 55,459 North American patients who include many patients from new ICUs, which helps confirm that the model is robust and was not overfitted to the development sample. Although Project IMPACT participants change over time, 2004-2005 patient risk factors and their relationship to hospital mortality have not significantly changed. The increase in mechanically ventilated patients and reduction in admissions with no risk factors are trends worth following.
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Critical care medicine · May 2009
Comparative StudySerum lactate is associated with mortality in severe sepsis independent of organ failure and shock.
Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis; however, it is plausible that elevated serum lactate is simply a manifestation of clinically apparent organ dysfunction and/or shock (i.e., refractory hypotension). ⋯ Initial serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients admitted to the ED with severe sepsis. Both intermediate and high serum lactate levels were independently associated with mortality.