Critical care : the official journal of the Critical Care Forum
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Multicenter Study
Off hour admission to an intensivist-led ICU is not associated with increased mortality.
Caring for the critically ill is a 24-hour-a-day responsibility, but not all resources and staff are available during off hours. We evaluated whether intensive care unit (ICU) admission during off hours affects hospital mortality. ⋯ The increased mortality after ICU admission during off hours is explained by a higher illness severity in patients admitted during off hours.
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Appropriate care for patients with tracheostomies in hospital settings is an important issue. Each year more than 7000 patients receive tracheostomies in Australia and New Zealand alone. Many of these tracheostomy patients commence their care in the intensive care unit (ICU) and once stabilised are then transferred to a general ward. Insufficient skills and experience of staff caring for tracheostomy patients may lead to sub-optimal care and increased morbidity. The purpose of this review was to identify whether multidisciplinary tracheostomy outreach teams enable the reduction in time to decannulation and length of stay in acute and sub-acute settings, improve quality of care or decrease adverse events for patients with a tracheostomy. ⋯ In the papers we appraised, patients with a tracheostomy tube in situ discharged from an ICU to a general ward who received care from a dedicated multidisciplinary team as compared with standard care showed reductions in time to decannulation, length of stay and adverse events. Impacts on quality of care were not reported.These results should be interpreted with caution due to the methodological weaknesses in the historical control studies.
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Comparative Study
Comparison between Flotrac-Vigileo and Bioreactance, a totally noninvasive method for cardiac output monitoring.
This study was designed to compare the clinical acceptability of two cardiac output (CO) monitoring systems: a pulse wave contour-based system (FloTrac-Vigileo) and a bioreactance-based system (NICOM), using continuous thermodilution (PAC-CCO) as a reference method. ⋯ This study showed that the NICOM and Vigileo devices have similar monitoring capabilities in post-operative cardiac surgery patients.
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Comparative Study
Clinical relevance of the severe abnormalities of the T cell compartment in septic shock patients.
Given the pivotal role of T lymphocytes in the immune system, patients with septic shock may show T cell abnormalities. We have characterised the T cell compartment in septic shock and assess its clinical implications. ⋯ A severe redistribution of T lymphocyte subsets is found in septic shock patients. A different kinetic pattern of T cell subset involvement is observed in surviving and nonsurviving patients, with lower numbers of circulating CD3+CD8+CD28+ and CD3+CD8+CD62L+ associated with a better disease outcome.
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Randomized Controlled Trial
A randomised controlled comparison of early post-pyloric versus early gastric feeding to meet nutritional targets in ventilated intensive care patients.
To compare outcomes from early post-pyloric to gastric feeding in ventilated, critically ill patients in a medical intensive care unit (ICU). ⋯ Early post-pyloric feeding offers no advantage over early gastric feeding in terms of overall nutrition received and complications