Intensive care medicine
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Intensive care medicine · Dec 2009
Meta AnalysisEarly enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials.
To determine whether the provision of early standard enteral nutrition (EN) confers treatment benefits to critically ill patients. ⋯ Although the detection of a statistically significant reduction in mortality is promising, overall trial quality was low, trial size was small, and the findings may be restricted to the patient groups enrolled into included trials. The results of this meta-analysis should be confirmed by the conduct of a large multi-centre trial enrolling diverse critically ill patient groups.
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Intensive care medicine · Dec 2009
Conflicts in the ICU: perspectives of administrators and clinicians.
The purpose of this study is to understand conflicts in the ICU setting as experienced by clinicians and administrators and explore methods currently used to resolve such conflicts when there may be discordance between clinicians and families, caregivers or administration. ⋯ There is considerable variability in dealing with conflicts in the ICU. Greater attention is needed at a systems level to support a culture aimed at prevention and resolution of conflicts to avoid increased sources of anxiety, stress and burnout.
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Intensive care medicine · Dec 2009
Family satisfaction in the intensive care unit: what makes the difference?
To assess family satisfaction in the ICU and to identify parameters for improvement. ⋯ The online version of this article (doi:10.1007/s00134-009-1611-4) contains supplementary material, which is available to authorized users.
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Intensive care medicine · Dec 2009
Serum procalcitonin levels in critically ill patients colonized with Candida spp: new clues for the early recognition of invasive candidiasis?
Invasive candidiasis (IC) outcomes in intensive care units (ICUs) could be improved by the early administration of antifungals. The Candida Score (CS) prediction rule has been proposed for the selection of patients who could develop IC. Procalcitonin (PCT) levels allow prompt identification of sepsis, but their behavior in the setting of IC is unclear. We hypothesize that PCT could be helpful in the early diagnosis of IC in patients with Candida sp. colonization. ⋯ After 7 days of hospitalization, PCT levels in patients with MF who go on to develop IC are higher than in others. Serum PCT could also improve the predictive value of CS. PCT together with CS could therefore be considered for the assessment of IC risk.
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Intensive care medicine · Dec 2009
Multicenter Study Comparative StudyMulticenter comparison of cortisol as measured by different methods in samples of patients with septic shock.
To compare inter-laboratory and inter-assay measurements of total cortisol in patients with septic shock and to evaluate current recommendations for diagnosis of corticosteroid insufficiency in septic shock. ⋯ In samples taken from patients in septic shock, there was a high inter-assay variation of total serum cortisol. Comparisons with a reference method revealed both over- and underestimations of true cortisol levels. These inter-assay variations in samples of patients with septic shock complicate the diagnosis of corticosteroid insufficiency.