Journal of critical care
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Journal of critical care · Mar 2010
Randomized Controlled TrialEffect of frequency of ventilator circuit changes (3 vs 7 days) on the rate of ventilator-associated pneumonia in PICU.
Ventilator-associated pneumonia (VAP) is associated with significant morbidity and mortality in pediatric intensive care unit (PICU). Our purpose was to evaluate the effects of ventilator circuit change on the rate of VAP in the PICU. ⋯ The 7-day ventilator circuit change did not contribute to increased rates of VAP in our PICU. Thus, it may be used as a guide to save workload and supply costs.
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Journal of critical care · Mar 2010
Randomized Controlled Trial Comparative StudyA carbohydrate-restrictive strategy is safer and as efficient as intensive insulin therapy in critically ill patients.
The aim of this study is to compare the safety and efficacy of 2 different strategies for glycemic control in critically ill adult patients. ⋯ A carbohydrate-restrictive strategy reduced significantly the incidence of hypoglycemia in critically ill patients compared to intensive insulin therapy. Mortality and morbidity were comparable between the 2 groups.
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Journal of critical care · Mar 2010
The Glucosafe system for tight glycemic control in critical care: a pilot evaluation study.
"Glucosafe' is a new model-based decision support system for glycemic control in critical care. Safety and achievement of glycemic goals using the system are tested prospectively. ⋯ Safety was demonstrated with the developed penalty functions. The low BG variance achieved may permit minor adjustments of the penalty function values to reduce average BG if desired.
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Journal of critical care · Mar 2010
Validity and reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients.
Delirium occurs frequently in critical care but often remains undiagnosed because delirium monitoring is often dismissed as being too time-consuming. This study determined the validity and reliability of the "CAM-ICU Flowsheet," a practical, time-sparing algorithm to assess the 4 delirium criteria in intubated patients. ⋯ The CAM-ICU Flowsheet has high sensitivity, high specificity, and very high interrater reliability. False-negative ratings can occur infrequently and mostly reflect the fluctuating course of delirium. The CAM-ICU Flowsheet is a valid, reliable, and quickly performed bedside delirium instrument.
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Journal of critical care · Mar 2010
Comparative StudyAccuracy of clinical definitions of ventilator-associated pneumonia: comparison with autopsy findings.
We studied patients requiring mechanical ventilation for more than 48 hours who died in the intensive care unit and whose bodies were autopsied. We evaluated 3 clinical definitions of ventilator-associated pneumonia: loose definition, defined as chest radiograph infiltrates and 2 of 3 clinical criteria (leukocytosis, fever, purulent respiratory secretions); rigorous definition, defined as chest radiograph infiltrates and all of the clinical criteria; and a clinical pulmonary infection score higher than 6 points. Sensitivity, specificity, and likelihood ratios were calculated by using pathology pattern as criterion standard. ⋯ Accuracy of 3 commonly used clinical definitions of ventilator-associated pneumonia was poor taking the autopsy findings as reference standard.