Critical care medicine
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Critical care medicine · May 2011
Review Meta AnalysisRelationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis of observational studies.
To determine whether catheter-associated urinary tract infections are associated with increased morbidity and mortality in critically ill patients. ⋯ Catheter-associated urinary tract infection is associated with significantly increased mortality and length of stay in unmatched studies. Increased mortality and possibly increased length of stay appear to be consequences of confounding by unmeasured variables. These findings highlight the importance of evaluating risks and benefits of commonly used treatments such as antibiotics to manage catheter-associated urinary tract infection.
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Critical care medicine · May 2011
Review Meta Analysis Comparative StudyThe effect of heparin administration in animal models of sepsis: a prospective study in Escherichia coli-challenged mice and a systematic review and metaregression analysis of published studies.
If thrombosis contributes to sepsis, heparin titrated using activated partial thromboplastin times may be efficacious. We investigated heparin in preclinical models. ⋯ Coagulopathy with sepsis or other variables, such as type of infectious source, may influence the efficacy of heparin therapy for sepsis.
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Critical care medicine · May 2011
Randomized Controlled Trial Multicenter Study Comparative StudyThe role of intestinal colonization with gram-negative bacteria as a source for intensive care unit-acquired bacteremia.
Selective digestive tract decontamination aims to eradicate gram-negative bacteria in both the intestinal tract and respiratory tract and is combined with a 4-day course of intravenous cefotaxime. Selective oropharyngeal decontamination only aims to eradicate respiratory tract colonization. In a recent study, selective digestive tract decontamination and selective oropharyngeal decontamination were associated with lower day-28 mortality, when compared to standard care. Furthermore, selective digestive tract decontamination was associated with a lower incidence of intensive care unit-acquired bacteremia caused by gram-negative bacteria. We quantified the role of intestinal tract carriage with gram-negative bacteria and intensive care unit-acquired gram-negative bacteremia. ⋯ Respiratory tract decolonization was associated with a 33% and intestinal tract decolonization was associated with a 45% reduction in the occurrence of intensive care unit-acquired gram-negative bacteremia.
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Critical care medicine · May 2011
Multicenter Study Comparative StudyComparing clinician ratings of the quality of palliative care in the intensive care unit.
There are numerous challenges to successfully integrating palliative care in the intensive care unit. Our primary goal was to describe and compare the quality of palliative care delivered in an intensive care unit as rated by physicians and nurses working in that intensive care unit. ⋯ Our study supports the content validity of the ten overall rating items and supports the need for improvement in several aspects of palliative care, including spiritual support for families, emotional support for clinicians, and clinician education about palliative care in the intensive care unit. Furthermore, our findings provide some preliminary support for surveying intensive care unit clinicians as one way to assess the quality of palliative care in the intensive care unit.