Critical care : the official journal of the Critical Care Forum
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Review
Monitoring trauma and intensive care unit resuscitation with tissue hemoglobin oxygen saturation.
The purpose of the present review is to review our experience with near-infrared spectroscopy (NIRS) monitoring in shock resuscitation and predicting clinical outcomes. ⋯ StO2 is an important tool in identifying high-risk patients in septic and hemorrhagic shock. It is a non-invasive means of obtaining vital information regarding outcome and adequacy of resuscitation.
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Comparative Study
Landmark survival as an end-point for trials in critically ill patients--comparison of alternative durations of follow-up: an exploratory analysis.
Interventional ICU trials have followed up patients for variable duration. However, the optimal duration of follow-up for the determination of mortality endpoint in such trials is uncertain. We aimed to determine the most logical and practical mortality end-point in clinical trials of critically ill patients. ⋯ A minimum of 90 days follow-up is necessary to fully capture the mortality effect of sepsis and community acquired pneumonia. A shorter period of follow-up time may be sufficient for non-operative trauma.
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In septic patients increased central drive and increased metabolic demands combine to increase energy demands on the ventilatory muscles. This occurs at a time when energy supplies are limited and energy production hindered, and it leads to an energy supply-demand imbalance and often ventilatory failure. ⋯ In this review I discuss factors related to ventilatory muscle failure, giving emphasis to mechanical and supply demand aspects. I also review the implications of changes in ventilatory patterns for heart-lung interactions.
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Great variability exists in data collection and coding of variables in studies on traumatic brain injury (TBI). This confounds comparison of results and analysis of data across studies. The difficulties in performing a meta-analysis of individual patient data were recently illustrated in the IMPACT project (International Mission on Prognosis and Clinical Trial Design in TBI): merging data from 11 studies involved over 10 person years of work. ⋯ Recommendations hereto have been proposed by an interagency initiative in the US. These proposals deserve to be taken forward at an international level. This initiative may well constitute one of the most important steps forwards, paving the road for harvesting successful results in the near future.
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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.