Critical care medicine
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Critical care medicine · Apr 2018
Multicenter Study Observational StudyTemporal Trends in Healthcare Costs and Outcome Following ICU Admission After Traumatic Brain Injury.
To assess temporal trends in 1-year healthcare costs and outcome of intensive care for traumatic brain injury in Finland. ⋯ During the last decade, healthcare costs of ICU-admitted traumatic brain injury patients have remained largely the same in Finland. No change in mortality was noted, but the risk for permanent disability decreased significantly. Thus, our results suggest that cost-effectiveness of traumatic brain injury care has improved during the past decade in Finland.
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Critical care medicine · Apr 2018
Delay Within the 3-Hour Surviving Sepsis Campaign Guideline on Mortality for Patients With Severe Sepsis and Septic Shock.
To specify when delays of specific 3-hour bundle Surviving Sepsis Campaign guideline recommendations applied to severe sepsis or septic shock become harmful and impact mortality. ⋯ The guideline recommendations showed that shorter delays indicates better outcomes. There was no evidence that 3 hours is safe; even very short delays adversely impact outcomes. Findings demonstrated a new approach to incorporate time t when analyzing the impact on outcomes and provide new evidence for clinical practice and research.
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To describe, with an emphasis on clinical applications, what is known about the pathophysiology, management, and implications of septic cardiomyopathy in the adult ICU. ⋯ Septic cardiomyopathy is an important contributor to organ dysfunction in sepsis. Guided treatment of septic cardiomyopathy may affect patients' prognosis, especially when their cardiac index is substantially decreased. The implication of septic cardiomyopathy for both short- and long-term outcomes is an important area for future investigation.
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Critical care medicine · Apr 2018
Multicenter StudyCulture-Negative Septic Shock Compared With Culture-Positive Septic Shock: A Retrospective Cohort Study.
To determine the clinical characteristics and outcomes of culture-negative septic shock in comparison with culture-positive septic shock. ⋯ Patients with culture-negative septic shock behave similarly to those with culture-positive septic shock in nearly all respects; early appropriate antimicrobial therapy appears to improve mortality. Early recognition and eradication of infection is the most obvious effective strategy to improve hospital survival.
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Critical care medicine · Apr 2018
A Comparative Analysis of Sepsis Identification Methods in an Electronic Database.
To evaluate the relative validity of criteria for the identification of sepsis in an ICU database. ⋯ The new organ dysfunction-based Sepsis-3 criteria have been proposed as a clinical method for identifying sepsis. These criteria identified a larger, less severely ill cohort than that identified by previously used administrative definitions. The Sepsis-3 criteria have several advantages over prior methods, including less susceptibility to coding practices changes, provision of temporal context, and possession of high construct validity. However, the Sepsis-3 criteria also present new challenges, especially when calculated retrospectively. Future studies on sepsis should recognize the differences in outcome incidence among identification methods and contextualize their findings according to the different cohorts identified.