Intensive care medicine
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Intensive care medicine · Jul 2018
Observational StudyEffects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study.
Chlorhexidine oral care is widely used in critically and non-critically ill hospitalized patients to maintain oral health. We investigated the effect of chlorhexidine oral care on mortality in a general hospitalized population. ⋯ These data argue against the indiscriminate widespread use of chlorhexidine oral care in hospitalized patients, in the absence of proven benefit in specific populations.
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Intensive care medicine · Jul 2018
Review Meta Analysis Comparative StudyLow-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis.
To assess the effect of low dose corticosteroids on outcomes in adults with septic shock. ⋯ In adults with septic shock treated with low dose corticosteroids, short- and longer-term mortality are unaffected, adverse events increase, but duration of shock, mechanical ventilation and ICU stay are reduced. PROSPERO registration no. CRD42017084037.
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Intensive care medicine · Jul 2018
Review Meta AnalysisOut-of-hours discharge from intensive care, in-hospital mortality and intensive care readmission rates: a systematic review and meta-analysis.
Discharge from an intensive care unit (ICU) out of hours is common. We undertook a systematic review and meta-analysis to explore the association between time of discharge and mortality/ICU readmission. ⋯ Out-of-hours discharge from an ICU is strongly associated with both in-hospital death and ICU readmission. These effects persisted across all definitions of "out of hours" and across healthcare systems in different geographical locations. Whether these increases in mortality and readmission result from patient differences, differences in care, or a combination remains unclear.
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Intensive care medicine · Jul 2018
Multicenter Study Observational StudyAcceleration of the learning curve for mastering basic critical care echocardiography using computerized simulation.
To assess the impact of computerized transthoracic echocardiography (TTE) simulation on the learning curve to achieve competency in basic critical care echocardiography (CCE). ⋯ Adjunctive computerized simulation accelerates the learning curve of basic CCE in improving practical and technical skills and reduces the number of TTE examinations required to reach competency.
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Intensive care medicine · Jul 2018
Multicenter Study Observational StudyCirculating biomarkers may be unable to detect infection at the early phase of sepsis in ICU patients: the CAPTAIN prospective multicenter cohort study.
Sepsis and non-septic systemic inflammatory response syndrome (SIRS) are the same syndromes, differing by their cause, sepsis being secondary to microbial infection. Microbiological tests are not enough to detect infection early. While more than 50 biomarkers have been proposed to detect infection, none have been repeatedly validated. ⋯ The circulating biomarkers tested were found to discriminate poorly between sepsis and non-septic SIRS, and no combination performed better than CRP alone.