Critical care medicine
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Critical care medicine · May 2014
Editorial CommentDecontaminate inside and out: two is better than one*.
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Critical care medicine · May 2014
Multicenter StudyImpact of Critical Care Nursing on 30-Day Mortality of Mechanically Ventilated Older Adults.
The mortality rate for mechanically ventilated older adults in ICUs is high. A robust research literature shows a significant association between nurse staffing, nurses' education, and the quality of nurse work environments and mortality following common surgical procedures. A distinguishing feature of ICUs is greater investment in nursing care. The objective of this study is to determine the extent to which variation in ICU nursing characteristics-staffing, work environment, education, and experience-is associated with mortality, thus potentially illuminating strategies for improving patient outcomes. ⋯ Patients in hospitals with better critical care nurse work environments and higher proportions of critical care nurses with a bachelor's degree in nursing experienced significantly lower odds of death.
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Critical care medicine · May 2014
Multicenter Study Comparative StudyOutcomes and Complications of Intracranial Pressure Monitoring in Acute Liver Failure: A Retrospective Cohort Study.
To determine if intracranial pressure monitor placement in patients with acute liver failure is associated with significant clinical outcomes. ⋯ In intracranial pressure monitored patients with acute liver failure, intracranial hypertension is commonly observed. The use of intracranial pressure monitor in acetaminophen acute liver failure did not confer a significant 21-day mortality benefit, whereas in nonacetaminophen acute liver failure, it may be associated with worse outcomes. Hemorrhagic complications from intracranial pressure monitor placement were uncommon and cannot account for mortality trends. Although our results cannot conclusively confirm or refute the utility of intracranial pressure monitoring in patients with acute liver failure, patient selection and ancillary assessments of cerebral blood flow likely have a significant role. Prospective studies would be required to conclusively account for confounding by illness severity and transplant.
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Critical care medicine · May 2014
Metabolic Profiling of Serum Samples by 1H Nuclear Magnetic Resonance Spectroscopy as a Potential Diagnostic Approach for Septic Shock.
To determine whether a nuclear magnetic resonance-based metabolomics approach can be useful for the early diagnosis and prognosis of septic shock in ICUs. ⋯ Our results indicate that nuclear magnetic resonance-based metabolic profiling could be used for diagnosis and mortality prediction of septic shock in the ICU.