Critical care medicine
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Critical care medicine · Aug 2011
Multicenter Study Comparative StudyRed cell distribution width and all-cause mortality in critically ill patients.
Red cell distribution width is a predictor of mortality in the general population. The prevalence of increased red cell distribution width and its significance in the intensive care unit are unknown. The objective of this study was to investigate the association between red cell distribution width at the initiation of critical care and all cause mortality. ⋯ Red cell distribution width is a robust predictor of the risk of all-cause patient mortality and bloodstream infection in the critically ill. Red cell distribution width is commonly measured, inexpensive, and widely available and may reflect overall inflammation, oxidative stress, or arterial underfilling in the critically ill.
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Critical care medicine · Aug 2011
Multicenter Study Comparative StudyOutcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality.
We evaluated the respective influence of the causative pathogen and infection site on hospital mortality from severe sepsis related to community-, hospital-, and intensive care unit-acquired infections. ⋯ The infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and, above all, appropriateness of early antimicrobials are taken into account. Our findings emphasize the importance of developing valid recommendations for early antimicrobial therapy.
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Critical care medicine · Aug 2011
Multicenter Study Comparative StudyUnderstanding the potential role of statins in pneumonia and sepsis.
To examine the association of statin use with clinical outcomes and circulating biomarkers in community-acquired pneumonia and sepsis. ⋯ We found no evidence of a protective effect for statin use on clinical outcomes and only modest differences in circulating biomarkers in community-acquired pneumonia, perhaps as a result of healthy user effects and indication bias.
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Critical care medicine · Aug 2011
Comparative StudyBrainstem responses can predict death and delirium in sedated patients in intensive care unit.
In critically ill patients, the assessment of neurologic function can be difficult because of the use of sedative agents. It is not known whether neurologic signs observed under sedation can predict short-term outcomes. The objective of this study was to assess whether abnormal brainstem responses within the first 24 hrs of sedation are associated with mortality and altered mental status postsedation. ⋯ Assessment of brainstem responses is feasible in sedated critically ill patients and loss of selected responses is predictive of mortality and altered mental status.
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Critical care medicine · Aug 2011
Multicenter Study Comparative StudyConstructing the illness narrative: a grounded theory exploring patients' and relatives' use of intensive care diaries.
After a stay in the intensive care unit, patients risk experiencing delusional memories, memory loss, and symptoms of posttraumatic stress. Since the 1990s, diaries have been kept for intensive care unit patients to help fill in memory gaps, aid psychosocial recovery, and improve health-related quality of life. More insight is needed into the application of diaries. The aim of our study was to explore how patients and relatives use diaries in the context of the illness trajectory. ⋯ Intensive care diaries are useful to patients as well as their relatives. Patients need to construct their illness narrative, and diaries are among the sources they use. The patients' project was to combine various sources of information in a process of information acquisition, narration, and evolving insight progressing toward recovery. The relatives supported the patients' project and also supported themselves by using the diary to uphold their own healing process. We recommend intensive care diaries as a low-technology, low-cost rehabilitative intervention for patients and relatives to help bridge the span from intensive care to recovery.