Critical care medicine
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Critical care medicine · May 2016
Multicenter StudyRelationship Between Peak Lactate and Patient Outcome Following High-Risk Gastrointestinal Surgery: Influence of the Nature of Their Surgery: Elective Versus Emergency.
The association between hyperlactatemia and adverse outcome in patients admitted to ICUs following gastrointestinal surgery has not been reported. To explore the hypothesis that in a large cohort of gastrointestinal surgical patients, the peak serum lactate (in the first 24 hr) observed in patients admitted to ICU following surgery is associated with unadjusted and severity-adjusted acute hospital mortality and that the strength of association is greater in patients admitted following "emergency" surgery than in patients admitted following "elective" surgery. ⋯ These findings have implications for our understanding of the role of lactate in critically ill patients.
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Critical care medicine · May 2016
Effects of Hyperoxia and Mild Therapeutic Hypothermia During Resuscitation From Porcine Hemorrhagic Shock.
Hemorrhagic shock-induced tissue hypoxia induces hyperinflammation, ultimately causing multiple organ failure. Hyperoxia and hypothermia can attenuate tissue hypoxia due to increased oxygen supply and decreased demand, respectively. Therefore, we tested the hypothesis whether mild therapeutic hypothermia and hyperoxia would attenuate postshock hyperinflammation and thereby organ dysfunction. ⋯ During resuscitation from near-lethal hemorrhagic shock, hyperoxia attenuated hyperinflammation, and thereby showed a favorable trend toward improved organ function. The lacking efficacy of hypothermia was most likely due to more pronounced barrier dysfunction with vascular leakage-induced circulatory failure.
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Critical care medicine · May 2016
Observational StudyPharmacodynamic Analysis of a Fluid Challenge.
This study aims to describe the pharmacodynamics of a fluid challenge over a 10-minute period in postoperative patients. ⋯ The maximal change in cardiac output should be assessed 1 minute after the end of the fluid infusion. The global effect of the fluid challenge on central venous pressure is greater in nonresponders, but not the change observed 10 minutes after the fluid infusion. The effect of a fluid challenge on hemodynamics is dissipated in 10 minutes similarly in both groups.
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Critical care medicine · May 2016
Individual and Clustered Rankability of ICUs According to Case-Mix-Adjusted Mortality.
The performance of ICUs can be compared by ranking them into a league table according to their risk-adjusted mortality rate. The statistical quality of a league table can be expressed as its rankability, the percentage of variation between ICUs attributable to unexplained differences. We examine whether we can improve the rankability of our league table by using data from a longer period or by grouping ICUs with similar performance constructing a league table of clusters rather than individual ICUs. ⋯ We conclude that, when using data from a single year, the rankability of a league table of Dutch ICUs based on risk-adjusted mortality rate was unacceptably low. We could improve the rankability of this league table by increasing the period of data collection or by grouping similar ICUs into clusters and constructing a league table of clusters of ICUs rather than individual ICUs. Ranking clusters of ICUs could be useful for identifying possible differences in performance between clusters of ICUs.