Critical care medicine
-
Critical care medicine · Nov 2010
Volume of emergency department admissions for sepsis is related to inpatient mortality: results of a nationwide cross-sectional analysis.
Emergency department resuscitation plays a significant role in sepsis care, and it is unknown if patient outcomes vary by institution based on the level of sepsis experience of the emergency department. This study examines whether there is an association between the annual volume of patients admitted via the emergency department with sepsis and inpatient mortality. ⋯ After adjustment for comorbidity and hospital-level factors, there was a significant relationship between emergency department sepsis case volume and overall and early inpatient mortality among patients admitted through the emergency department with sepsis. Patients admitted to hospitals in the highest-volume quartile had 27% lower odds of inpatient mortality in this large heterogeneous sample.
-
Critical care medicine · Nov 2010
Rescue therapy in adult and pediatric patients with pH1N1 influenza infection: a tertiary center intensive care unit experience from April to October 2009.
Severe respiratory failure is a well-recognized complication of pH1N1 influenza infection. Limited data regarding the efficacy of rescue therapies, including high-frequency oscillatory ventilation and extracorporeal membrane oxygenation, have been previously reported in the setting of pH1N1 influenza infection in the United States. ⋯ In critically ill adult and pediatric patients with pH1N1 infection and severe lung injury, the use of high-frequency oscillatory ventilation and extracorporeal membrane oxygenation can result in significant improvements in Pao²/Fio² ratio, oxygenation index, and Fio². However, the impact on mortality is less certain.
-
Critical care medicine · Nov 2010
Age still matters: prognosticating short- and long-term mortality for critically ill patients with pneumonia.
To determine the association between age and mortality in critically ill patients with pneumonia. We hypothesized that increasing age would be independently associated with both short- and long-term mortality. ⋯ Increasing age was independently associated with risk-adjusted short- and long-term mortality in critically ill patients with pneumonia. These findings may help elderly patients, their families, and physicians better understand what intensive care unit admission can offer and help them to make more informed decisions.
-
Critical care medicine · Nov 2010
The effects of epinephrine on outcomes of normothermic and therapeutic hypothermic cardiopulmonary resuscitation.
To investigate the effects of epinephrine when administered during either normothermic or therapeutic hypothermic cardiopulmonary resuscitation on postresuscitation myocardial and cerebral function and survival. ⋯ Epinephrine, when administered during normothermic cardiopulmonary resuscitation, significantly increases the severity of postresuscitation myocardial dysfunction and decreases the duration of survival. These detrimental effects of epinephrine, however, no longer exist when it is administered during therapeutic hypothermic cardiopulmonary resuscitation.
-
Critical care medicine · Nov 2010
Review Meta AnalysisProcalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and meta-analysis of randomized controlled trials.
There is increasing interest for strategies that could curtail antibiotic resistance in the critical care setting. We sought to determine the effectiveness and safety of procalcitonin-guided algorithms in the management of septic patients in the intensive care unit. ⋯ The implementation of a procalcitonin-based algorithm may reduce antibiotic exposure in critically ill, septic patients without compromising clinical outcomes, but further research is necessary before the wide adoption of this strategy.