Annals of intensive care
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Annals of intensive care · Dec 2015
Low-dose corticosteroid treatment and mortality in refractory abdominal septic shock after emergency laparotomy.
The role of low-dose corticosteroid as an adjunctive treatment for abdominal septic shock remains controversial. ⋯ Low-dose corticosteroid administration may be associated with reduced in-hospital mortality in patients with refractory septic shock following emergency laparotomy for lower intestinal perforation.
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Most studies about septic shock report a crude mortality rate that neither distinguishes between early and late deaths nor addresses the direct causes of death. We herein aimed to determine the modalities of death in septic shock. ⋯ Our study provides a comprehensive assessment of septic shock-related deaths. Identification of risk factors of early and late deaths may determine differential prognostic patterns.
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Annals of intensive care · Dec 2015
Long-term survival and quality of life after intensive care for patients 80 years of age or older.
Comparison of survival and quality of life in a mixed ICU population of patients 80 years of age or older with a matched segment of the general population. ⋯ Overall 1-year survival was 42.0 %. Survival rates beyond that were comparable to those of the general octogenarian population. Among survivors at follow-up, HRQOL was comparable to that of the age- and sex-matched general population. Patients admitted for planned surgery had better short- and long-term survival rates than those admitted for medical reasons or unplanned surgery for 3 years after ICU admittance. The majority of the ICU non-survivors died within 2 days, and most of these had LST limitation decisions.
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Annals of intensive care · Dec 2015
Automatic versus manual changeovers of norepinephrine infusion pumps in critically ill adults: a prospective controlled study.
Norepinephrine is a key drug for treating shock but has a short half-life that requires continuous intravenous administration to maintain the constant plasma concentration needed to obtain a stable blood pressure. The small volume of the syringes used in power infusion pumps requires frequent changeovers, which can lead to norepinephrine flow interruptions responsible for hemodynamic instability. Changeovers from the nearly empty to the full syringe can be performed manually using the quick change technique (QC) or automatically using smart infusion pumps (SIP) that link two syringes. The purpose of our study was to evaluate the hypothesis that, compared to QC, SIP for norepinephrine changeovers was associated with less hemodynamic instability. ⋯ The risk of MAP drops ≥20 % during changeovers can be significantly diminished using SIPs instead of the QC method.
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Annals of intensive care · Dec 2015
Admission vitamin D status is associated with discharge destination in critically ill surgical patients.
Discharge destination after critical illness is increasingly recognized as a valuable patient-centered outcome. Recently, vitamin D status has been shown to be associated with important outcomes such as length of stay (LOS) and mortality in intensive care unit (ICU) patients. Our goal was to investigate whether vitamin D status on ICU admission is associated with discharge destination. ⋯ Our results suggest that vitamin D status may be a modifiable risk factor for non-home discharge destination in surgical ICU patients. Future randomized, controlled trials are needed to determine whether vitamin D supplementation in surgical ICU patients can improve clinical outcomes such as the successful rate of discharge to home after critical illness.