Critical care medicine
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Critical care medicine · Sep 2009
Comparative StudyGender impact on the outcomes of critically ill patients with nosocomial infections.
: To investigate gender impact on the outcomes of severe nosocomial infections (pneumonia, bacteremia, catheter-related bloodstream infections, poststernotomy mediastinitis, urinary infections) occurring in a large cohort of patients hospitalized in a medical-surgical intensive care unit. Highly controversial data exist regarding gender-related differences in outcomes of severe nosocomial infections, reflecting potential confounders related to case-mixes or heterogeneity of populations evaluated. ⋯ : Female intensive care unit patients developing nosocomial infections seem to be at increased risk of intensive care unit mortality, after carefully controlling for other prognostic factors. Further studies are needed to elucidate the pathophysiology underlying this gender-related difference, to devise tailored gender-specific therapies that might improve outcomes.
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Critical care medicine · Sep 2009
Comparative StudyCan bacteriological upper airway samples obtained at intensive care unit admission guide empiric antibiotherapy for ventilator-associated pneumonia?
: Ventilator-associated pneumonia is associated with an increase in morbidity and mortality. The delay before adequate antibiotherapy is known to influence patients' outcome. We hypothesized that the results of upper airways samples performed at immediately intensive care unit admission could help the clinician to choose the adequate empiric antibiotherapy for a ventilator-associated pneumonia occurring during the first 5 days of intensive care unit admission. ⋯ : In this study, we found high specificities and likelihood ratios for upper airways samples to predict the microorganisms involved in a ventilator-associated pneumonia. These results suggest that upper airways samples might provide an adjunctive assistance in selecting therapy for ventilator-associated pneumonia.
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Critical care medicine · Sep 2009
Nonexcitable muscle membrane predicts intensive care unit-acquired paresis in mechanically ventilated, sedated patients.
: To investigate the predictive value of electrophysiological measurements including validation of muscle membrane excitability on the development of intensive care unit (ICU)-aquired paresis. ⋯ : Abnormal dmCMAP occurred within the first week after admission to the ICU and pointed towards a myopathic process as the primary cause of ICU-acquired paresis. Validation of dmCMAP with onset of critical illness allows an early prediction of ICU-acquired paresis and adds important information to clinical estimation of the patients' motor function.