Critical care medicine
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Critical care medicine · Oct 2017
Prevalence and Prognostic Association of Circulating Troponin in the Acute Respiratory Distress Syndrome.
Circulating cardiac troponin has been associated with adverse prognosis in the acute respiratory distress syndrome in small and single-center studies; however, comprehensive studies of myocardial injury in acute respiratory distress syndrome using modern high-sensitivity troponin assays, which can detect troponin at much lower circulating concentrations, have not been performed. ⋯ Circulating troponin is detectable in over 90% of patients with acute respiratory distress syndrome and is associated with degree of critical illness. The magnitude of myocardial injury correlated with mortality.
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Critical care medicine · Oct 2017
Observational StudySafety Hazards During Intrahospital Transport: A Prospective Observational Study.
To identify, classify, and describe safety hazards during the process of intrahospital transport of critically ill patients. ⋯ Findings suggest that intrahospital transport is a hazardous process for critically ill patients. We have identified several factors that may contribute to transport-related adverse events, which will provide the opportunity for the redesign of systems to enhance patient safety.
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Critical care medicine · Oct 2017
Observational StudySevere Respiratory Failure, Extracorporeal Membrane Oxygenation, and Intracranial Hemorrhage.
For patients supported with veno-venous extracorporeal membrane oxygenation, the occurrence of intracranial hemorrhage is associated with a high mortality. It is unclear whether intracranial hemorrhage is a consequence of the extracorporeal intervention or of the underlying severe respiratory pathology. In a cohort of patients transferred to a regional severe respiratory failure center that routinely employs admission brain imaging, we sought 1) the prevalence of intracranial hemorrhage; 2) survival and neurologic outcomes; and 3) factors associated with intracranial hemorrhage. ⋯ We report a higher prevalence of intracranial hemorrhage than has previously been described with high level of neurologically intact survival. Duration of mechanical ventilation and admission fibrinogen, but not exposure to extracorporeal support, are independently associated with intracranial hemorrhage.
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Critical care medicine · Oct 2017
Association Between Survival and Time of Day for Rapid Response Team Calls in a National Registry.
Decreased staffing at nighttime is associated with worse outcomes in hospitalized patients. Rapid response teams were developed to decrease preventable harm by providing additional critical care resources to patients with clinical deterioration. We sought to determine whether rapid response team call frequency suffers from decreased utilization at night and how this is associated with patient outcomes. ⋯ Rapid response team activation is less frequent during the early morning and is followed by a spike in mortality in the 7 AM hour. These findings suggest that failure to rescue deteriorating patients is more common overnight. Strategies aimed at improving rapid response team utilization during these vulnerable hours may improve patient outcomes.
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Critical care medicine · Oct 2017
Does Admission to the ICU Prevent African American Disparities in Withdrawal of Life-Sustaining Treatment?
We sought to determine whether black patients admitted to an ICU were less likely than white patients to withdraw life-sustaining treatments. ⋯ This study suggests that Black patients may be less likely to withdraw life-supportive measures than whites, but that this disparity may be absent in patients who spend time in the ICU during their hospitalization.