Critical care medicine
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Critical care medicine · Jul 2016
Randomized Controlled Trial Multicenter Study Comparative StudyUse of the GlideScope Ranger Video Laryngoscope for Emergency Intubation in the Prehospital Setting: A Randomized Control Trial.
We sought to assess whether the GlideScope Ranger video laryngoscope may be a reliable alternative to direct laryngoscopy in the prehospital setting. ⋯ Video laryngoscopy is an established tool in difficult airway management, but our results shed light on the specific problems in the emergency medical service setting. Prehospital use of the GlideScope was associated with some major problems, thus resulting in a lower intubation success rate when compared with direct laryngoscopy.
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Critical care medicine · Jul 2016
ReviewThe Fragility Index in Multicenter Randomized Controlled Critical Care Trials.
Recent literature has drawn attention to the potential inadequacy of frequentist analysis and threshold p values as tools for reporting outcomes in clinical trials. The fragility index, which is a measure of how many events the statistical significance of a result depends on, has been suggested as a means to aid the interpretation of trial results. This study aimed to calculate the fragility index of clinical trials in critical care medicine reporting a statistically significant effect on mortality (increasing or decreasing mortality). ⋯ In critical care trials reporting statistically significant effects on mortality, the findings often depend on a small number of events. Critical care clinicians should be wary of basing decisions on trials with a low fragility index. We advocate the reporting of fragility index for future trials in critical care to aid interpretation and decision making by clinicians.
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Critical care medicine · Jul 2016
Multicenter StudyMicrovesicle Tissue Factor Activity and Interleukin-8 Levels are Associated with Mortality in Patients with Influenza A/H1N1 Infection.
To identify plasma biomarkers that can be early predictors of mortality in critically ill patients with primary influenza A/H1N1. ⋯ This study identifies an association between plasma interleukin-8 and microvesicle tissue factor activity measured on admission in patients with severe, primary influenza A/H1N1 infection and subsequent mortality. Thus, these biomarkers may serve as very early prognostic markers for patients with influenza A/H1N1.
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Critical care medicine · Jul 2016
Observational StudyMechanical Ventilation and Diaphragmatic Atrophy in Critically Ill Patients: An Ultrasound Study.
Mechanical ventilation contributes to diaphragmatic atrophy and dysfunction, and few techniques exist to assess diaphragmatic function: the purpose of this study was to quantify diaphragm atrophy in a population of critically ill mechanically ventilated patients with ultrasound and to identify risk factors that can worsen diaphragmatic activity. ⋯ In critically ill mechanically ventilated patients, there is a linear relationship between ventilator support and diaphragmatic atrophy rate.
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In the United States, sepsis is a major public health problem accounting for over 200,000 annual deaths. The aims of this study were to identify U.S. counties with high sepsis mortality and to assess the community characteristics associated with increased sepsis mortality. ⋯ Sepsis mortality is higher in the Southern United States, with three regional clusters: "Mississippi Valley," "Middle Georgia," and "Central Appalachia": Regions of high sepsis mortality are characterized by lower education, income, employment, and insurance coverage.