Critical care medicine
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Critical care medicine · Apr 2014
Using Electronic Health Record Data to Develop and Validate a Prediction Model for Adverse Outcomes in the Wards.
Over 200,000 in-hospital cardiac arrests occur in the United States each year and many of these events may be preventable. Current vital sign-based risk scores for ward patients have demonstrated limited accuracy, which leads to missed opportunities to identify those patients most likely to suffer cardiac arrest and inefficient resource utilization. We derived and validated a prediction model for cardiac arrest while treating ICU transfer as a competing risk using electronic health record data. ⋯ We developed and validated a prediction tool for ward patients that can simultaneously predict the risk of cardiac arrest and ICU transfer. Our model was more accurate than the VitalPAC Early Warning Score and could be implemented in the electronic health record to alert caregivers with real-time information regarding patient deterioration.
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Critical care medicine · Apr 2014
Multicenter StudyThe Association of Red Cell Distribution Width at Hospital Discharge and Out-of-Hospital Mortality Following Critical Illness.
Red cell distribution width is associated with mortality and bloodstream infection risk in the critically ill. In hospitalized patients with critical illness, it is not known if red cell distribution width can predict subsequent risk of all-cause mortality following hospital discharge. We hypothesized that an increase in red cell distribution width at hospital discharge in patients who survived to discharge following critical care would be associated with increased postdischarge mortality. ⋯ In patients treated with critical care who survive hospitalization, an elevated red cell distribution width at the time of discharge is a robust predictor of subsequent all-cause patient mortality. Increased discharge red cell distribution width likely reflects the presence of proinflammatory state, oxidative stress, arterial underfilling, or a combination, thereof which may explain the observed impact on patient survival following discharge. Elevated red cell distribution width at hospital discharge may identify ICU survivors who are at risk for adverse outcomes following hospital discharge.
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Critical care medicine · Apr 2014
Review Meta AnalysisLiberal Versus Restricted Fluid Resuscitation Strategies in Trauma Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies.
Initial liberal fluid resuscitation strategies in trauma patients may be associated with higher mortality.
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Critical care medicine · Apr 2014
ReviewEnteral Nutrition in the Critically Ill: Myths and Misconceptions.
Nutritional support is an essential component of the management of critically ill and injured ICU patients. Optimal provision of calories and protein has been demonstrated to reduce morbidity, mortally, and length of ICU and hospital stay. Yet, a large proportion of ICU patients receive inadequate nutrition. ⋯ A number of common myths and misconceptions appear to play a major role in limiting the provision of enteral nutrition in the critically ill. This article provides scientific data to debunk the most common myths and misconceptions related to enteral nutrition.