Critical care medicine
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Critical care medicine · Sep 2020
Observational StudyICU and Ventilator Mortality Among Critically Ill Adults With Coronavirus Disease 2019.
To determine mortality rates among adults with critical illness from coronavirus disease 2019. ⋯ Despite multiple reports of mortality rates exceeding 50% among critically ill adults with coronavirus disease 2019, particularly among those requiring mechanical ventilation, our early experience indicates that many patients survive their critical illness.
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Critical care medicine · Sep 2020
Implications of Obesity for the Management of Severe Coronavirus Disease 2019 Pneumonia.
To investigate patients' characteristics, management, and outcomes in the critically ill population admitted to the ICU for severe acute respiratory syndrome coronavirus disease 2019 pneumonia causing an acute respiratory distress syndrome. ⋯ In its most severe form, coronavirus disease 2019 pneumonia striked preferentially the vulnerable obese population, evolved toward a multiple organ failure, required prolonged mechanical ventilatory support, and resulted in a high workload for the caregivers.
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Critical care medicine · Sep 2020
Trends, Cost, and Mortality From Sepsis After Trauma in the United States: An Evaluation of the National Inpatient Sample of Hospitalizations, 2012-2016.
Identification and outcomes in patients with sepsis have improved over the years, but little data are available in patients with trauma who develop sepsis. We aimed to examine the cost and epidemiology of sepsis in patients hospitalized after trauma. ⋯ While national trends for sepsis mortality have improved over the years, our analysis of National Inpatient Sample did not support this trend in the trauma population. The odds risk for death after sepsis and the cost of care remained high regardless of severity of injury. More rigor is needed in tracking sepsis after trauma and evaluating the effectiveness of hospital mandates and policies to improve sepsis care in patients after trauma.
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Critical care medicine · Sep 2020
Incidence of Venous Thromboembolism in Critically Ill Coronavirus Disease 2019 Patients Receiving Prophylactic Anticoagulation.
One of the defining features of the novel coronavirus disease 2019 infection has been high rates of venous thromboses. The present study aimed to describe the prevalence of venous thromboembolism in critically ill patients receiving different regimens of prophylactic anticoagulation. ⋯ Deep venous thrombosis is very common in critically ill patients with coronavirus disease 2019. There was no difference in incidence of deep venous thrombosis among different pharmacologic prophylaxis regimens, although our analysis is limited by small sample size. D-dimer values are elevated in the majority of these patients, but there may be thresholds at which screening ultrasound or even empiric systemic anticoagulation is indicated.
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Critical care medicine · Sep 2020
Multicenter StudyThe Use of Physical Therapy ICU Assessments to Predict Discharge Home.
To establish cutoff values for making recommendations for discharge to the home setting using standardized physical therapy assessments. ⋯ The Functional Status Score for the ICU and the ICU Mobility Scale were collected during the initial physical therapy assessment, at ICU discharge, and prior to hospital discharge. The Activity Measure for Post-Acute Care-Inpatient Mobility Short Form "6 clicks" was only collected during the initial physical therapy assessment. Receiver Operating Characteristic curves were used to determine a potential cutoff value for discharge home. The Receiver Operating Characteristic was adjusted for ICU and hospital length of stay along with mobility status prior to hospital admission. Cutoff values were then determined by using Youden's Index. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated based on these cut off values. The Functional Status Score for the ICU at ICU discharge was the best predictor of a discharge to the home setting in patients who had an ICU admission. The area under the curve for the Functional Status Score for the ICU at ICU discharge was 0.80. A Functional Status Score for the ICU score at ICU discharge of 19 or higher predicted discharge to home with a sensitivity of 82.9% and specificity of 73.6% CONCLUSIONS:: The Functional Status Score for the ICU at ICU discharge provided the best accuracy for making a timely recommendation for discharge home in patients who had an ICU admission.