Critical care : the official journal of the Critical Care Forum
-
Most prognostic models rely on variables recorded within 24 hours of admission to predict the mortality rate of patients in the intensive care unit (ICU). Although a significant number of patients die after discharge from the ICU, there is a paucity of data related to predicting hospital mortality based on information obtained at ICU discharge. It is likely that experienced intensivists may be able to predict the likelihood of hospital death at ICU discharge accurately if they incorporate patients' age, preferences regarding life support, comorbidities, prehospital quality of life, and clinical course in the ICU into their prediction. However, if it is to be generalizable and reproducible and to perform well without bias, then a good prediction model should be based on objectively defined variables.
-
Editorial Comment
Corticosteroids to prevent postextubation upper airway obstruction: the evidence mounts.
Intubation of the airway can lead to laryngotracheal injury, resulting in extubation failure from upper airway obstruction (UAO). A number of factors can help to identify patients who are at greatest risk for postextubation UAO. Three randomized controlled trials demonstrate that prophylactic corticosteroids decrease the risk for postextubation UAO and probably the need for re-intubation.
-
The origin of hyperlactataemia during critical illness is complex but its presence can provide an indicator of inadequate tissue oxygen delivery. Cardiopulmonary bypass (CPB) represents a unique situation where systemic oxygen delivery can be directly measured and controlled. In the previous issue of Critical Care, Ranucci and colleagues use this phenomenon to identify independent variables associated with the development of hyperlactataemia during CPB. In doing so they highlight the complexity of interpreting hyperlactataemia during critical illness and provide further evidence of its association with worse postoperative morbidity.
-
Comparative Study
Causes of metabolic acidosis in canine hemorrhagic shock: role of unmeasured ions.
Metabolic acidosis during hemorrhagic shock is common and conventionally considered to be due to hyperlactatemia. There is increasing awareness, however, that other nonlactate, unmeasured anions contribute to this type of acidosis. ⋯ Large amounts of unmeasured anions were generated after hemorrhage in this highly standardized model of hemorrhagic shock. Capillary electrophoresis suggested that the hitherto unmeasured anions citrate and acetate, but not sulfate, contributed significantly to the changes in strong ion gap associated with induction of shock.
-
A body of knowledge exists to suggest an association between nurse staffing and adverse patient outcomes. Hugonnet and colleagues add further evidence by linking nurse staffing to late-onset ventilator-associated pneumonia. Discussed are a number of concerns surrounding the analytic component of this study, including the construction of variables and the statistical models. The authors' estimation that hospitals maintaining a nurse-to-patient ratio above 2.2 could decrease the risk of health care associated infections is based on findings that are potentially biased and unrealistic.