Critical care medicine
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Critical care medicine · Jun 2014
The Process of Prehospital Airway Management: Challenges and Solutions During Paramedic Endotracheal Intubation.
Endotracheal intubation success rates in the prehospital setting are variable. Our objective was to describe the challenges encountered and corrective actions taken during the process of endotracheal intubation by paramedics. ⋯ Airway management in the prehospital setting has substantial challenges. Success can require a collection of adjustments that involve equipment, personnel, and medication often in a simultaneous fashion.
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Critical care medicine · Jun 2014
Multicenter Study Observational StudyArterial Blood Gas Tensions After Resuscitation From Out-of-Hospital Cardiac Arrest: Associations With Long-Term Neurological Outcome.
In patients resuscitated after out-of-hospital cardiac arrest, mean 24 hour PaCO2 predicted good outcome, specifically time spent with PaCO2 > 45 mmHg. No similar associations could be found between mean 24 h PaO2 and outcome.
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Critical care medicine · Jun 2014
Comment Review Meta AnalysisArterial Catheters as a Source of Bloodstream Infection: A Systematic Review and Meta-Analysis.
Catheter-related bloodstream infections are associated with significant costs and adverse consequences. Arterial catheters are commonly used in the critical care setting and are among the most heavily manipulated vascular access devices. We sought to evaluate the prevalence of arterial catheter-related bloodstream infection. ⋯ Forty-nine studies met criteria including 222 cases of arterial catheter-related bloodstream infection in 30,841 catheters. Pooled incidence was 3.40/1,000 catheters or 0.96/1,000 catheter days. Prevalence was considerably higher in the subgroup of studies that cultured all catheters (1.26/1,000 catheter days) compared with those studies that cultured only when the arterial catheter was suspected as the source for the catheter-related bloodstream infection (0.70/1,000 catheter days). Pooled data also found a significantly increased risk of infection for femoral site of insertion compared with radial artery for arterial catheter placement (relative risk, 1.93; 95% CI, 1.32-2.84; p = 0.001) CONCLUSIONS: Arterial catheters are an underrecognized cause of catheter-related bloodstream infection. Pooled incidence when catheters were systematically cultured and correlated to blood culture results indicated a substantial burden of arterial catheter-related bloodstream infection. Selection of a radial site over a femoral site will help reduce the risk of arterial catheter-related bloodstream infection. Future studies should evaluate technologies applied to preventing central venous catheter-related bloodstream infection to arterial catheters as well.
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Critical care medicine · Jun 2014
Clinical TrialConservative Oxygen Therapy in Mechanically Ventilated Patients: A Pilot Before-and-After Trial.
To assess the feasibility and safety of a conservative approach to oxygen therapy in mechanically ventilated ICU patients. ⋯ Conservative oxygen therapy in mechanically ventilated ICU patients was feasible and free of adverse biochemical, physiological, or clinical outcomes while allowing a marked decrease in excess oxygen exposure. Our study supports the safety and feasibility of future pilot randomized controlled trials of conventional compared with conservative oxygen therapy.
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Critical care medicine · Jun 2014
Multicenter Study Observational StudyStress Hyperlactatemia Modifies the Relationship Between Stress Hyperglycemia and Outcome: A Retrospective Observational Study.
To study the effect of stress hyperlactatemia on the association between stress hyperglycemia and mortality. ⋯ Stress hyperlactatemia modifies the relationship between hyperglycemia and mortality. There is no independent association between hyperglycemia and mortality once lactate levels are considered.