Critical care medicine
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Critical care medicine · Jan 2011
Inappropriate antibiotic therapy in Gram-negative sepsis increases hospital length of stay.
To describe the impact of initially inappropriate antibiotic therapy on hospital length of stay in Gram-negative severe sepsis and septic shock. ⋯ Initially inappropriate antibiotic therapy occurs in one-third of persons with severe sepsis and septic shock attributable to Gram-negative organisms. Beyond its impact on mortality, initially inappropriate antibiotic therapy is significantly associated with length of stay in this population. Efforts to decrease rates of initially inappropriate antibiotic therapy may serve to improve hospital resource use by leading to shorter overall hospital stays.
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Critical care medicine · Jan 2011
Comparative StudyBiomarkers increase detection of active smoking and secondhand smoke exposure in critically ill patients.
The association between tobacco smoke exposure and critical illness is not well studied, largely because obtaining an accurate smoking history from critically ill patients is difficult. Biomarkers can provide quantitative data on active and secondhand cigarette smoke exposure. We sought to compare cigarette smoke exposure as measured by biomarkers to exposure by self-report in a cohort of critically ill patients and to determine how well biomarkers of cigarette smoke exposure correlate with each other in this population. ⋯ The combination of serum cotinine and urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol identified considerably more active smokers than did smoking history and detected a high prevalence of secondhand smoke exposure in a critically ill population. These markers will be important for future studies investigating the relationship between active smoking and secondhand smoke exposure and critical illness.
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Critical care medicine · Jan 2011
Comparative StudyDo-not-attempt-resuscitation orders and prognostic models for intraparenchymal hemorrhage.
Statistical models predicting outcome after intraparenchymal hemorrhage include patients irrespective of do-not-attempt-resuscitation orders. We built a model to explore how the inclusion of patients with do-not-attempt-resuscitation orders affects intraparenchymal hemorrhage prognostic models. ⋯ Although our prognostic model was well-calibrated when assessing all intraparenchymal hemorrhage patients, predictions were significantly pessimistic in patients without and optimistic in those with do-not-attempt-resuscitation orders. Such pessimism may drive decisions not to attempt resuscitation in patients in whom a favorable outcome may have been possible, thereby creating a self-fulfilling prophecy. To be most useful in clinical decision making, intraparenchymal hemorrhage prognostic models should be calibrated to large intraparenchymal hemorrhage cohorts in whom do-not-attempt-resuscitation orders were not used.
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Critical care medicine · Jan 2011
Editorial Comment Comparative StudyMild therapeutic hypothermia after cardiac arrest: Keep on chilling.
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Critical care medicine · Jan 2011
Comparative StudyPersistent low microcirculatory vessel density in nonsurvivors of sepsis in pediatric intensive care.
To investigate the time course and predictive value of microvascular alterations in children with severe sepsis. ⋯ Persistent microcirculatory alterations can be prognostic for survival in children with septic shock.