Annals of intensive care
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Annals of intensive care · Dec 2016
Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation.
Bleeding is the most frequent complication associated with extracorporeal membrane oxygenation (ECMO) support in critically ill patients. Nonetheless, risk factors for bleeding have been poorly described especially those associated with coagulation anomalies and anticoagulant therapy during ECMO support. The aim of this study is to describe bleeding complications in critically ill patients undergoing ECMO and to identify risk factors for bleeding events. ⋯ Bleeding events based on the ELSO bleeding definition occurred in more than 60 % of ECMO episodes and were associated with hospital mortality. We identified higher aPTT prior bleeding as an independent risk factor for bleeding event, suggesting that better control of the aPTT (through a better control of either coagulopathy or anticoagulation) may improve patients' outcome.
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Annals of intensive care · Dec 2016
Predictors of posttraumatic stress and quality of life in family members of chronically critically ill patients after intensive care.
Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. ⋯ Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.
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Annals of intensive care · Dec 2016
Combination of C-reactive protein, procalcitonin and sepsis-related organ failure score for the diagnosis of sepsis in critical patients.
To measure the ability of a new bioscore to diagnose sepsis in a general critical care population. ⋯ This bioscore using CRP, PCT and SOFA score may potentially be used in the future to help identify septic patients earlier, improving their access to timely treatment modalities.
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Annals of intensive care · Dec 2016
End-tidal carbon dioxide variation after a 100- and a 500-ml fluid challenge to assess fluid responsiveness.
EtCO2 variation has been advocated replacing cardiac output measurements to evaluate fluid responsiveness (FR) during sepsis. The ability of EtCO2 variation after a fluid challenge to detect FR in the context of general anaesthesia has not been investigated. Forty patients were prospectively studied. They underwent general anaesthesia for major surgeries. CO was measured by transoesophageal Doppler, and EtCO2 was recorded as well as other haemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), pulse pressure (PP)] at baseline, after 100-ml fluid load over 1 min, and at the end of the 500-ml fluid load. We measured the variation of EtCO2 at 100 (ΔEtCO2100) and 500 ml (ΔEtCO2500), and ROC curves were generated. A threshold for ΔEtCO2 to predict FR was determined with receiver operating curves (ROC) analysis. The primary end point was the ability of EtCO2 variation after a 500-ml fluid load to diagnose FR. ⋯ During surgery, when alveolar ventilation and CO2 production are constant, ΔEtCO2500 is fairly reliable to assess FR. When the variation of EtCO2 is >5.8 %, all patients were responders, but no conclusion could be done when this variation was <5.8 %. ΔEtCO2100 failed to predict FR. Trial registration CPP Lyon Sud Est III ref: 2013-027 B, Number ID RCB: 2013-A00729-36 delivered by the ANSM).
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Annals of intensive care · Dec 2016
Predictors of haemodynamic instability during the changeover of norepinephrine infusion pumps.
Changeovers of norepinephrine infusion pumps (CNIPs) frequently lead to haemodynamic instability. The aim of this study was to identify risk factors for haemodynamic instability associated with CNIP, independent of the method used to perform the relay. ⋯ Changes in the norepinephrine concentration during CNIPs lead to a high risk of haemodynamic instability, while the clinical severity of patients, as well as the doses of norepinephrine, was not.