Articles: intensive-care-units.
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Critical care medicine · Mar 2023
Randomized Controlled Trial Multicenter StudyImproving ICU Risk Predictive Models Through Automation Designed for Resiliency Against Documentation Bias.
Electronic health records enable automated data capture for risk models but may introduce bias. We present the Philips Critical Care Outcome Prediction Model (CCOPM) focused on addressing model features sensitive to data drift to improve benchmarking ICUs on mortality performance. ⋯ These mortality risk models demonstrated excellent performance compared with APACHE while appearing to mitigate bias introduced through major shifts in GCS documentation at two large health systems. This provides evidence to support using automated capture rather than trained personnel for capture of GCS data used in benchmarking ICUs on mortality performance.
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Comment Meta Analysis
In adults receiving mechanical ventilation, selective decontamination of the digestive tract reduces hospital mortality.
Hammond NE, Myburgh J, Seppelt I, et al. Association between selective decontamination of the digestive tract and in-hospital mortality in intensive care unit patients receiving mechanical ventilation: a systematic review and meta-analysis. JAMA. 2022;328:1922-34. 36286098.
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Minerva anestesiologica · Mar 2023
Long-term effects of Coronavirus 2 infection after intensive care: a prospective study.
While the multi-organ manifestations of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection are now well-documented, the potential long-term implications of these manifestations remain to be uncovered. The aim of the study was to study the level and predictors of post-traumatic stress, anxiety and depression symptoms, quality of life and functional disability in COVID-19 survivors during the first year post Intensive Care Unit (ICU) discharge. ⋯ Our results show that functional and cognitive recovery improves between six and 12 months after ICU discharge with a high perception of the patients' quality of life. These results will help to inform health system planning and the development of multidisciplinary strategies to reduce chronic health loss among individuals with COVID-19.
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Observational Study
Defining a postoperative mean arterial pressure threshold in association with acute kidney injury after cardiac surgery: a prospective observational study.
Acute kidney injury (AKI) is a common but fatal complication after cardiac surgery. In the absence of effective treatments, the identification and modification of risk factors has been a major component of disease management. However, the optimal blood pressure target for preventing cardiac surgery-associated acute kidney injury (CSA-AKI) remains unclear. ⋯ Among the 353 patients enrolled, 217 (61.5%) had a confirmed diagnosis of CSA-AKI. Each 1 h epoch of postoperative MAP less than 65 mmHg was associated with an adjusted odds ratio of 1.208 (95% CI, 1.007 to 1.449; P = 0.042), and each 1 h epoch of postoperative MAP between 65 and 74 mmHg was associated with an adjusted odds ratio of 1.144 (95% CI, 1.026 to 1.275; P = 0.016) for CSA-AKI. A potentially modifiable risk factor, postoperative MAP less than 75 mmHg for 1 h or more is associated with an increased risk of CSA-AKI.