Critical care medicine
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Critical care medicine · Aug 2017
Observational StudyAntibiotic Therapy in Comatose Mechanically Ventilated Patients Following Aspiration: Differentiating Pneumonia From Pneumonitis.
To determine the proportion of patients with documented bacterial aspiration pneumonia among comatose ICU patients with symptoms suggesting either bacterial aspiration pneumonia or non-bacterial aspiration pneumonitis. ⋯ Among comatose patients receiving mechanical ventilation, those without clinical, laboratory, or radiologic evidence of bacterial aspiration pneumonia did not require antibiotics. In those with suspected bacterial aspiration pneumonia, stopping empirical antibiotic therapy when routine telescopic plugged catheter sampling recovered no microorganisms was nearly always effective. This strategy may be a valid alternative to routine full-course antibiotic therapy. Only half the patients with suspected bacterial aspiration pneumonia had this diagnosis confirmed by telescopic plugged catheter sampling.
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Critical care medicine · Aug 2017
Case ReportsLower Cranial Nerves Paralysis Following Prone-Position Mechanical Ventilation.
To communicate a complication of prone-position ventilation. ⋯ This is a very infrequent cause of dysphagia following prone-position ventilation.
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Critical care medicine · Aug 2017
Case ReportsAtriobronchial Fistula Complicated by Septic Cerebral Air Emboli After Pulmonary Vein Ablation.
To describe a case of an infected atriobronchial fistula as a late complication after pulmonary vein ablation, leading to septic air emboli and requiring urgent cardiac surgery. ⋯ Clinicians should be aware of the dramatic complications of invasive antiarrhythmic procedures and their atypical and late presentations. Better preprocedural appreciation of cardiac wall thickness, early echocardiographic diagnosis, and swift referral for cardiac surgery might impact outcome dramatically.
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Critical care medicine · Aug 2017
Validation of an Administrative Definition of ICU Admission Using Revenue Center Codes.
Describe the operating characteristics of a proposed set of revenue center codes to correctly identify ICU stays among hospitalized patients. ⋯ Use of the proposed combination of revenue center codes has excellent sensitivity and specificity for identifying true ICU admission. A classification and regression tree algorithm with additional administrative variables offers further improvements to accuracy.