Critical care medicine
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Critical care medicine · May 2013
Review Meta Analysis Comparative StudyHigh-osmolarity saline in neurocritical care: systematic review and meta-analysis.
Intracranial hypertension and cerebral edema are known contributors to secondary brain injury and to poor neurologic outcomes. Small volume solutions of exceedingly high osmolarity, such as 23.4% saline, have been used for the management of intracranial hypertension crises and as a measure to prevent or reverse acute brain tissue shifts. We conducted a systematic literature review on the use of 23.4% saline in neurocritically ill patients and a meta-analysis of the effect of 23.4% saline on intracranial pressure reduction. ⋯ Highly concentrated hypertonic saline such as 23.4% provides a small volume solution with low cost and an over 50% reduction effect on raised intracranial pressure. Side effects reported are minor overall in view of the potentially catastrophic event that is being treated. High quality data are still needed to define the most appropriate osmotherapeutic agent, the optimal dose, the safest and most effective mode of administration and to further elucidate the mechanism of action of 23.4% saline and of osmotherapy in general.
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Critical care medicine · May 2013
Multicenter Study Comparative StudyRenal perfusion assessment by renal Doppler during fluid challenge in sepsis.
To assess renal resistive index variations in response to fluid challenge. ⋯ Systemic hemodynamic changes induced by fluid challenge do not translate into resistive index variations in patients without acute kidney injury, with transient acute kidney injury, or with persistent acute kidney injury.
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Critical care medicine · May 2013
Multicenter Study Comparative StudyDevelopment of a genomic metric that can be rapidly used to predict clinical outcome in severely injured trauma patients.
Many patients have complicated recoveries following severe trauma due to the development of organ injury. Physiological and anatomical prognosticators have had limited success in predicting clinical trajectories. We report on the development and retrospective validation of a simple genomic composite score that can be rapidly used to predict clinical outcomes. ⋯ A rapid genomic composite score obtained in the first 24 hours after trauma can retrospectively identify trauma patients who are likely to develop complicated clinical trajectories. A novel platform is described in which this genomic score can be obtained within 12 hours of blood collection, making it available for clinical decision making.
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Critical care medicine · May 2013
Multicenter Study Comparative StudyExtents of white matter lesions and increased intraventricular extension of intracerebral hemorrhage.
To determine whether the extent of white matter lesions on a CT scan of acute intracerebral hemorrhage patients is associated with the prevalence and severity of intraventricular extension of hemorrhage. ⋯ We documented that the severity of white matter lesions is related to the occurrence and amount of intraventricular extension of hemorrhage in spontaneous intracerebral hemorrhage cases.
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Critical care medicine · May 2013
Review Comparative StudyDeterminants of mortality after hospital discharge in ICU patients: literature review and Dutch cohort study.
First, to conduct a literature review on the long-term mortality of ICU patients and its determinants. Second, to assess the influence of the found determinants at 3, 6, and 12 months mortality after hospital discharge in the Dutch ICU population. ⋯ The long-term mortality found in the included articles was difficult to compare due to low quality, variation in case-mix, study design, and differences in case-mix adjustment. The most commonly used determinants in the literature were comparable to the most important determinants found in the Dutch cohort study.