Critical care medicine
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Critical care medicine · Sep 2009
Randomized Controlled TrialRandomized trial of light versus deep sedation on mental health after critical illness.
: To investigate if light sedation favorably affects subsequent patient mental health compared with deep sedation. Symptoms of posttraumatic stress disorder are common in patients after they have undergone prolonged mechanical ventilation and are associated with sedation depth. ⋯ : These data suggest that a strategy of light sedation affords benefits with regard to reduction of intensive care unit stay and duration of ventilation without negatively affecting subsequent patient mental health or patient safety.
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Critical care medicine · Sep 2009
Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study.
: To examine the effect of severity of acute kidney injury or renal recovery on risk-adjusted mortality across different intensive care unit settings. Acute kidney injury in intensive care unit patients is associated with significant mortality. ⋯ : Admission diagnosis and severity of illness influence frequency and severity of acute kidney injury. Small elevations in creatinine in the intensive care unit are associated with increased risk-adjusted mortality across all intensive care unit settings, whereas renal recovery was associated with a protective effect. Strategies to prevent even mild acute kidney injury or promote renal recovery may improve survival.
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Critical care medicine · Sep 2009
Randomized Controlled TrialEarly exercise in critically ill patients enhances short-term functional recovery.
: To investigate whether a daily exercise session, using a bedside cycle ergometer, is a safe and effective intervention in preventing or attenuating the decrease in functional exercise capacity, functional status, and quadriceps force that is associated with prolonged intensive care unit stay. A prolonged stay in the intensive care unit is associated with muscle dysfunction, which may contribute to an impaired functional status up to 1 yr after hospital discharge. No evidence is available concerning the effectiveness of an early exercise training intervention to prevent these detrimental complications. ⋯ : Early exercise training in critically ill intensive care unit survivors enhanced recovery of functional exercise capacity, self-perceived functional status, and muscle force at hospital discharge.
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Critical care medicine · Sep 2009
Clostridium difficile-associated disease and mortality among the elderly critically ill.
: To describe the epidemiology of and to develop a simple 30-day mortality clinical decision rule among critically ill patients > or =65 yrs. Increasing incidence of hospitalizations with and emergence of hypervirulent epidemic strains have made Clostridium difficile-associated disease an important public health concern. Advanced age is a risk factor for development of and death from Clostridium difficile-associated disease. Intensive care unit patients with Clostridium difficile-associated disease have a high mortality, but neither the burden of nor risk factors for death among the elderly intensive care unit patients with Clostridium difficile-associated disease are well understood. ⋯ : Elderly patients represent approximately 50% of intensive care unit patients with Clostridium difficile-associated disease and have a higher 30-day mortality than younger patients. A simple prediction rule incorporating determinants of 30-day mortality easily available at the bedside may aid in optimizing treatment decisions in this growing population.
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Critical care medicine · Sep 2009
Burden of early-onset candidemia: analysis of culture-positive bloodstream infections from a large U.S. database.
: To characterize the epidemiology and burden of early-onset, nonnosocomial candidemia. ⋯ : Early-onset candidemia seems to be a distinct entity, which is increasing in frequency and is associated with increased mortality risk, longer hospital stay, and higher hospital costs relative to bacterial bloodstream infection.