Critical care medicine
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Critical care medicine · Aug 2013
Bacteremia in patients with acute pancreatitis as revealed by 16S ribosomal RNA gene-based techniques*.
To define the characteristic of bacteremia in patients with acute pancreatitis and determine its possible association with the disease severity. ⋯ This study provides a detailed description on the prevalence of bacteremia and characteristic of bacterial species in patients with acute pancreatitis. We demonstrate an association between the bacteremia and the disease severity, which enables us to better understand a potential role of bacterial translocation in the pathogenesis of septic complication in acute pancreatitis.
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Fever is common and associated with increased mortality among patients admitted to adult ICUs, yet recent literature suggests that the incidence of fever may be decreasing. The objective of this study was to determine whether the incidence of fever in adult ICUs changed over time and the factors responsible for the observed change. ⋯ The incidence of fever in adult ICUs decreased considerably over time. The lack of change in the ordering of blood cultures and the incidence of bloodstream infections calls into question the importance of fever during the diagnostic evaluation of critically ill patients.
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Critical care medicine · Aug 2013
Effect of plasma-to-RBC ratios in trauma patients: a cohort study with time-dependent data*.
A widespread approach today is to transfuse bleeding trauma patients with RBC concentrates and plasma at a 1:1 ratio. This regime is supported by a range of observational studies showing lower mortality in bleeding patients receiving equal volumes of plasma and RBCs. The rationale for this practice is still unclear with several studies failing to show any survival benefits of increased plasma use, perhaps due to a failure to account for the timing of transfused units. ⋯ The key finding in our study is the strikingly different results produced by time-dependent analyses and the conventional analyses when studying survival and plasma-to-RBC ratio, supporting recent claims that prior studies showing benefit of high plasma ratios might have suffered from survival bias. There is a great need for further studies on the subject to enable improvements in treatment of massively bleeding trauma patients.
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Critical care medicine · Aug 2013
Focused transthoracic echocardiography during critical care medicine training: curriculum implementation and evaluation of proficiency*.
We designed and implemented a focused transthoracic echocardiography curriculum for critical care medicine fellows participating in 1- and 2-year training programs. We quantitatively evaluated their proficiency in focused transthoracic echocardiography. ⋯ A focused transthoracic echocardiography curriculum that includes quantitative measures of proficiency can be integrated into critical care medicine fellowship training programs.
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Critical care medicine · Aug 2013
Case ReportsUsefulness of combined bedside lung ultrasound and echocardiography to assess weaning failure from mechanical ventilation: a suggestive case*.
Recognition of the cardiac origin of weaning failure is a crucial issue for successful discontinuation of mechanical ventilation. Bedside lung ultrasound and echocardiography have shown a potential in predicting weaning failure. Objective of this report was to describe the case of a patient repeatedly failing to wean from mechanical ventilation, where the combined use of lung ultrasound and echocardiography during a spontaneous breathing trial uncovered an unexpected cause of the failure. ⋯ The use of bedside lung ultrasound and echocardiography disclosed left ventricular diastolic dysfunction as unexpected cardiogenic cause of weaning failure and lead to subsequent correct patient management.