Critical care medicine
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Critical care medicine · Apr 2015
Comparative Study Observational StudyDifferences in Vital Signs Between Elderly and Nonelderly Patients Prior to Ward Cardiac Arrest.
Vital signs and composite scores, such as the Modified Early Warning Score, are used to identify high-risk ward patients and trigger rapid response teams. Although age-related vital sign changes are known to occur, little is known about the differences in vital signs between elderly and nonelderly patients prior to ward cardiac arrest. We aimed to compare the accuracy of vital signs for detecting cardiac arrest between elderly and nonelderly patients. ⋯ Vital signs more accurately detect cardiac arrest in nonelderly patients compared with elderly patients, which has important implications for how they are used for identifying critically ill patients. More accurate methods for risk stratification of elderly patients are necessary to decrease the occurrence of this devastating event.
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Critical care medicine · Apr 2015
Frequency, Cost, and Risk Factors of Readmissions Among Severe Sepsis Survivors.
To determine the frequency, mortality, cost, and risk factors associated with readmission after index hospitalization with severe sepsis. ⋯ The 30-day and 180-day readmissions are common in sepsis survivors with significant resultant cost and mortality. Patient sociodemographics and comorbidities as well as index hospitalization characteristics are associated with 30-day readmission rates.
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Critical care medicine · Apr 2015
Septic Shock Sera Containing Circulating Histones Induce Dendritic Cell-Regulated Necrosis in Fatal Septic Shock Patients.
Innate immune system alterations, including dendritic cell loss, have been reproducibly observed in patients with septic shock and correlated to adverse outcomes or nosocomial infections. The goal of this study is to better understand the mechanisms behind this observation in order to better assess septic shock pathogenesis. ⋯ The study demonstrates a differential mechanism of dendritic cell death in patients with septic shock that is dependent on the severity of the disease.
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Critical care medicine · Apr 2015
Observational StudyDerivation and Validation of the Acute Organ Failure Score to Predict Outcome in Critically Ill Patients: A Cohort Study.
Prediction models for ICU mortality rely heavily on physiologic variables that may not be available in large retrospective studies. An alternative approach when physiologic variables are absent stratifies mortality risk by acute organ failure classification. ⋯ An acute organ failure-based clinical prediction model shows good calibration and discrimination for 30-day mortality in the critically ill. The clinical prediction model compares favorably to Acute Physiologic and Chronic Health Evaluation II score in the prediction of 30-day mortality in the critically ill. This score may be useful for severity of illness risk adjustment in observational studies where physiologic data are unavailable.
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Critical care medicine · Apr 2015
Comparative StudySodium Nitroprusside-Enhanced Cardiopulmonary Resuscitation Facilitates Intra-Arrest Therapeutic Hypothermia in a Porcine Model of Prolonged Ventricular Fibrillation.
The aim of this study was to assess the effect of sodium nitroprusside-enhanced cardiopulmonary resuscitation on heat exchange during surface cooling. We hypothesized that sodium nitroprusside-enhanced cardiopulmonary resuscitation would decrease the time required to reach brain temperature less than 35°C compared to active compression-decompression plus impedance threshold device cardiopulmonary resuscitation alone, in the setting of intra-cardiopulmonary resuscitation cooling. We further hypothesized that the addition of epinephrine during sodium nitroprusside-enhanced cardiopulmonary resuscitation would mitigate heat exchange. ⋯ This study demonstrates that sodium nitroprusside-enhanced cardiopulmonary resuscitation facilitates intra-cardiopulmonary resuscitation hypothermia. The addition of epinephrine to sodium nitroprusside-enhanced cardiopulmonary resuscitation during cardiopulmonary resuscitation reduced its improvement in heat exchange.