Critical care medicine
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Critical care medicine · Apr 2014
Activation of a Medical Emergency Team Using an Electronic Medical Recording-Based Screening System.
To evaluate the efficacy of a medical emergency team activated using 24-hour monitoring by electronic medical record-based screening criteria followed by immediate intervention by a skilled team. ⋯ We successful managed the medical emergency team with electronic medical record-based screening criteria and a skilled intervention team. The electronic medical record-triggered group had lower ICU admission than the call-triggered group or the double-triggered group. In surgical patients, the electronic medical record-triggered group showed better outcome than other groups.
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Critical care medicine · Apr 2014
Do Physicians Have Lower Risk of Severe Sepsis and Associated Mortality? A Matched Cohort Study.
Physicians generally have higher disease awareness and easier access to medical care, which may help them reduce risk of developing severe sepsis and associated mortality when they suffer from acute infection. However, the opposite situation may occur due to the presence of potential barriers to healthcare in physicians. We aim to examine the risk of severe sepsis and associated mortality in physicians. ⋯ These findings support the hypothesis that physicians are less likely than controls to develop or die of severe sepsis, implying that medical knowledge, higher disease awareness, and easier healthcare access in physicians may help reduce their risk of severe sepsis and associated mortality.
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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
The Association Between Renal Replacement Therapy Modality and Long-Term Outcomes Among Critically Ill Adults With Acute Kidney Injury: A Retrospective Cohort Study.
Among critically ill patients with acute kidney injury, the impact of renal replacement therapy modality on long-term kidney function is unknown. Compared with conventional intermittent hemodialysis, continuous renal replacement therapy may promote kidney recovery by conferring greater hemodynamic stability; yet continuous renal replacement therapy may not enhance patient survival and is resource intense. Our objective was to determine whether continuous renal replacement therapy was associated with a lower risk of chronic dialysis as compared with intermittent hemodialysis, among survivors of acute kidney injury. ⋯ Compared with intermittent hemodialysis, initiation of continuous renal replacement therapy in critically ill adults with acute kidney injury is associated with a lower likelihood of chronic dialysis.
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Critical care medicine · Apr 2014
Troponin Elevation in Severe Sepsis and Septic Shock: The Role of Left Ventricular Diastolic Dysfunction and Right Ventricular Dilatation.
Serum troponin concentrations predict mortality in almost every clinical setting they have been examined, including sepsis. However, the causes for troponin elevations in sepsis are poorly understood. We hypothesized that detailed investigation of myocardial dysfunction by echocardiography can provide insight into the possible causes of troponin elevation and its association with mortality in sepsis. ⋯ Left ventricular diastolic dysfunction and right ventricular dilatation are the echocardiographic variables correlating best with concomitant high-sensitivity troponin-T concentrations. Left ventricular diastolic and right ventricular systolic dysfunction seem to explain the association of troponin with mortality in severe sepsis and septic shock.