Critical care medicine
-
Critical care medicine · Aug 2015
Multicenter StudyPatient Mortality Is Associated With Staff Resources and Workload in the ICU: A Multicenter Observational Study.
Matching healthcare staff resources to patient needs in the ICU is a key factor for quality of care. We aimed to assess the impact of the staffing-to-patient ratio and workload on ICU mortality. ⋯ This study proposes evidence-based thresholds for patient-to-caregiver ratios, above which patient safety may be endangered in the ICU. Real-time monitoring of staffing levels and workload is feasible for adjusting caregivers' resources to patients' needs.
-
Critical care medicine · Aug 2015
Goal-Directed Resuscitative Interventions During Pediatric Interfacility Transport.
This article reports results of the first National Institutes of Health-funded prospective interfacility transport study to determine the effect of goal-directed therapy administered by a specialized pediatric team to critically ill children with the systemic inflammatory response syndrome. We hypothesized that goal-directed therapy during interfacility transport would decrease hospital length of stay, prevent multiple organ dysfunction, and reduce subsequent ICU interventions. ⋯ This study suggests that goal-directed therapy administered by a specialized pediatric transport team has the potential to impact the outcomes of critically ill children. Findings from this study should be confirmed across multiple institutions, but have the potential to impact the clinical outcomes of critically ill children with systemic inflammatory response syndrome.
-
Critical care medicine · Aug 2015
A Multibiomarker-Based Model for Estimating the Risk of Septic Acute Kidney Injury.
The development of acute kidney injury in patients with sepsis is associated with worse outcomes. Identifying those at risk for septic acute kidney injury could help to inform clinical decision making. We derived and tested a multibiomarker-based model to estimate the risk of septic acute kidney injury in children with septic shock. ⋯ We have derived and tested a model to estimate the risk of septic acute kidney injury on day 3 of septic shock using a novel panel of biomarkers. The model had very good performance in a test cohort and has test characteristics supporting clinical utility and further prospective evaluation.
-
Critical care medicine · Aug 2015
Multicenter StudyTransient and Persistent Acute Kidney Injury and the Risk of Hospital Mortality in Critically Ill Patients: Results of a Multicenter Cohort Study.
To assess the prognostic impact of transient and persistent acute kidney injury in critically ill patients. ⋯ Two thirds of the critically ill patients with acute kidney injury have persistent acute kidney injury. Although mortality increased progressively with the duration of acute kidney injury, we found no independent association between this duration and patient outcome when the acute kidney injury severity is taken into account. Our results suggest that the classical "prerenal acute kidney injury" and "acute tubular necrosis" paradigm might be of limited interest from a pathophysiological or prognostic point of view.
-
Critical care medicine · Aug 2015
Multicenter StudyExternal Ventricular and Lumbar Drain Device Infections in ICU Patients: A Prospective Multicenter Italian Study.
Use of external ventricular drains and lumbar catheters is associated with a risk of ventriculitis and meningitis ranging from 2% to 24% because of lack of standardized diagnostic criteria. We evaluated the prevalence of ventriculitis or meningitis in 13 Italian ICUs. ⋯ Ventriculitis or meningitis remains a problem in Italian ICUs, and a strategy for reducing the prevalence is worth planning.