Critical care medicine
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Critical care medicine · Feb 2012
Randomized Controlled Trial Multicenter Study Comparative StudyEffects of methylprednisolone infusion on markers of inflammation, coagulation, and angiogenesis in early acute respiratory distress syndrome.
Evaluate the effects of methylprednisolone on markers of inflammation, coagulation, and angiogenesis during early acute respiratory distress syndrome. ⋯ In early acute respiratory distress syndrome, administration of methylprednisolone was associated with improvement in important biomarkers of inflammation and coagulation and clinical outcomes. Biomarker changes varied with the precipitating cause of acute respiratory distress syndrome, suggesting that the underlying mechanisms and response to anti-inflammatory therapy may vary with the cause of acute respiratory distress syndrome.
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Critical care medicine · Feb 2012
Randomized Controlled Trial Multicenter Study Comparative StudyA multifaceted program for improving quality of care in intensive care units: IATROREF study.
To test the effects of three multifaceted safety programs designed to decrease insulin administration errors, anticoagulant prescription and administration errors, and errors leading to accidental removal of endotracheal tubes and central venous catheters, respectively. Medical errors and adverse events are associated with increased mortality in intensive care patients, indicating an urgent need for prevention programs. ⋯ A multifaceted program was effective in preventing insulin errors and accidental tube/catheter removal. Significant Hawthorne effects occurred, emphasizing the need for appropriately designed studies before definitively implementing strategies.
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Critical care medicine · Feb 2012
Multicenter Study Comparative StudyZero risk for central line-associated bloodstream infection: are we there yet?.
Identify the longest period a central line remains free from central line-associated bloodstream infection during an 18-month insertion-bundle project. ⋯ The success of the insertion bundle was identified by improved analysis that identified that the safest dwell time was extended to the first 9 days for centrally inserted lines and up to day 7 for dialysis, peripherally inserted central catheters, and unspecified central line types. Given that three quarters of intensive care unit patients have their central line removed by day 7, zero risk for central line-associated bloodstream infection should be achievable in the majority of patients where clinicians comply with the clinician and patient insertion bundles.
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Critical care medicine · Feb 2012
Randomized Controlled Trial Comparative StudyEffect of the bevel direction of puncture needle on success rate and complications during internal jugular vein catheterization.
Artery puncture and hematoma formation are the most common immediate complications during internal jugular vein catheterization. This study was performed to assess whether the bevel-down approach of the puncture needle decreases the incidence of posterior venous wall damage and hematoma formation during internal jugular vein catheterization. ⋯ The bevel-down approach of the right internal jugular vein may decrease the incidence of posterior venous wall damage and hematoma formation compared with the bevel-up approach, which implicates a reduced probability of carotid artery puncture with the bevel-down approach during internal jugular vein catheterization.
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Critical care medicine · Feb 2012
Poststroke delirium incidence and outcomes: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).
To describe the epidemiology and time spectrum of delirium using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and to validate a tool for delirium assessment in patients in the acute poststroke period. ⋯ Poststroke delirium may frequently be detected provided that the testing algorithm is appropriate to the time profile of poststroke delirium. Early (first day after stroke onset) and serial screening for delirium is recommended. CAM-ICU is a valid instrument for the diagnosis of delirium and should be considered an aid in delirium screening and assessment in future epidemiologic and interventional studies in patients with stroke.