Critical care medicine
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Critical care medicine · Sep 2009
Review Meta AnalysisDynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature.
: A systematic review of the literature to determine the ability of dynamic changes in arterial waveform-derived variables to predict fluid responsiveness and compare these with static indices of fluid responsiveness. The assessment of a patient's intravascular volume is one of the most difficult tasks in critical care medicine. Conventional static hemodynamic variables have proven unreliable as predictors of volume responsiveness. Dynamic changes in systolic pressure, pulse pressure, and stroke volume in patients undergoing mechanical ventilation have emerged as useful techniques to assess volume responsiveness. ⋯ : Dynamic changes of arterial waveform-derived variables during mechanical ventilation are highly accurate in predicting volume responsiveness in critically ill patients with an accuracy greater than that of traditional static indices of volume responsiveness. This technique, however, is limited to patients who receive controlled ventilation and who are not breathing spontaneously.
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Critical care medicine · Sep 2009
Multicenter Study Comparative StudyEffect of work-hours regulations on intensive care unit mortality in United States teaching hospitals.
: To examine the association of the resident work-hours reform with mortality for patients in medical and surgical intensive care units. The United States instituted restrictions on resident work-hours in July 2003. The clinical impact of this reform on critically ill patients is unknown. ⋯ : There was a decrease in in-hospital mortality in intensive care unit patients during the years of observation. This decrease was not associated with hospital teaching status, suggesting no net positive or negative association of the resident work-hours regulations with a major patient-centered outcome.
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Critical care medicine · Sep 2009
Multicenter StudyDiscontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study.
To describe current practice for the discontinuation of continuous renal replacement therapy in a multinational setting and to identify variables associated with successful discontinuation. The approach to discontinue continuous renal replacement therapy may affect patient outcomes. However, there is lack of information on how and under what conditions continuous renal replacement therapy is discontinued. ⋯ We report on the current practice of discontinuing continuous renal replacement therapy in a multinational setting. Urine output at the time of initial cessation of continuous renal replacement therapy was the most important predictor of successful discontinuation, especially if occurring without the administration of diuretics.
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Critical care medicine · Sep 2009
Randomized Controlled TrialHypoglycemia with intensive insulin therapy in critically ill patients: predisposing factors and association with mortality.
: To examine the predisposing factors for hypoglycemia in medical-surgical intensive care unit patients treated with intensive insulin therapy and to assess its association with mortality. ⋯ : Our study showed significant increase of hypoglycemia with intensive insulin therapy. Although hypoglycemia was not independently associated with increased risk of death, increased mortality could not be excluded with severe hypoglycemia and in patients admitted with blood glucose of < or =10 mmol/L.
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Critical care medicine · Sep 2009
Randomized Controlled TrialPredicting the risk of documented ventilator-associated pneumonia for benchmarking: construction and validation of a score.
: To build and validate a ventilator-associated pneumonia risk score for benchmarking. The rate of ventilator-associated pneumonia varies widely with case-mix, a fact that has limited its use for measuring intensive care unit performance. ⋯ : The ventilator-associated pneumonia rate may be useful for benchmarking provided the ratio of observed over theoretical rates is used. External validation of our prediction score is needed.