Critical care medicine
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Critical care medicine · Aug 2017
Organizational Issues, Structure, and Processes of Care in 257 ICUs in Latin America: A Study From the Latin America Intensive Care Network.
Latin America bears an important burden of critical care disease, yet the information about it is scarce. Our objective was to describe structure, organization, processes of care, and research activities in Latin-American ICUs. ⋯ This multinational study shows major concerns in the delivery of critical care across Latin America, particularly in human resources. Technology was suboptimal, especially in public hospitals. A 24/7 availability of supporting specialists and of key procedures was inadequate. Mortality was high in comparison to high-income countries.
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Critical care medicine · Aug 2017
Observational StudyCerebral Recovery Index: Reliable Help for Prediction of Neurologic Outcome After Cardiac Arrest.
Early electroencephalography measures contribute to outcome prediction of comatose patients after cardiac arrest. We present predictive values of a new cerebral recovery index, based on a combination of quantitative electroencephalography measures, extracted every hour, and combined by the use of a random forest classifier. ⋯ A cerebral recovery index based on a combination of intermittently extracted, optimally combined quantitative electroencephalography measures provides unequalled prognostic value for comatose patients after cardiac arrest and enables bedside EEG interpretation of unexperienced readers.
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Critical care medicine · Aug 2017
Multicenter StudyRepeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs.
To determine the occurrence rate of unplanned readmissions to PICUs within 1 year and examine risk factors associated with repeated readmission. ⋯ Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with complex chronic conditions and particular conditions were at much higher risk for readmission.
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Critical care medicine · Aug 2017
Multicenter StudyBoth Positive and Negative Fluid Balance May Be Associated With Reduced Long-Term Survival in the Critically Ill.
Among critically ill patients with acute kidney injury, exposure to positive fluid balance, compared with negative fluid balance, has been associated with mortality and impaired renal recovery. However, it is unclear whether positive and negative fluid balances are associated with poor outcome compared to patients with even fluid balance (euvolemia). In this study, we examined the association between exposure to positive or negative fluid balance, compared with even fluid balance, on 1-year mortality and renal recovery. ⋯ Among critically ill patients, exposure to positive or negative fluid balance, compared with even fluid balance, was associated with higher 1-year mortality. This mortality risk associated with positive fluid balance, however, was attenuated by use of renal replacement therapy. We found no association between fluid balance and renal recovery.