Journal of critical care
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Journal of critical care · Mar 2010
Comparative StudyImproving blood sugar control during critical illness: a cohort study.
The aim of this study is to compare blood sugar control and safety profile of nurse-titrated and medically ordered glucose-insulin regimens. ⋯ In a regional ICU, nurse-titrated glycemic control is safe, effective, and results in high compliance with a glucose target range.
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Journal of critical care · Mar 2010
The impact of the initial ventilatory strategy on survival in hematological patients with acute hypoxemic respiratory failure.
The aim of this study was to assess the impact of the 3 types of initial respiratory support (noninvasive positive pressure ventilation vs invasive positive pressure ventilation vs supplemental oxygen only) in hematological patients with acute hypoxemic respiratory failure (ARF). ⋯ Intensive care unit and in-hospital mortality in our population of hematological patients with hypoxemic ARF was determined by severity of illness and not by the type of initial respiratory support.
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Journal of critical care · Mar 2010
Collection of annotated data in a clinical validation study for alarm algorithms in intensive care--a methodologic framework.
Monitoring of physiologic parameters in critically ill patients is currently performed by threshold alarm systems with high sensitivity but low specificity. As a consequence, a multitude of alarms are generated, leading to an impaired clinical value of these alarms due to reduced alertness of the intensive care unit (ICU) staff. To evaluate a new alarm procedure, we currently generate a database of physiologic data and clinical alarm annotations. ⋯ The presented system for collecting real-time bedside monitoring data in conjunction with video-assisted annotations of clinically relevant events is the first allowing the assessment of 24-hour periods and reduces the bias usually created by bedside observers in comparable studies. It constitutes the basis for the development and evaluation of "smart" alarm algorithms, which may help to reduce the number of alarms at the ICU, thereby improving patient safety.
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Journal of critical care · Mar 2010
Delirium in patients admitted to a step-down unit: analysis of incidence and risk factors.
Delirium is a rather common complication among patients admitted in intensive care units (ICUs), and rather than a single entity, it can be considered a spectrum of diseases where, besides overt cases, there are also many subsyndromal forms. Although there are many data about ICU delirium, there are few data concerning this complication in patients transferred from the ICU to a step-down unit (SDU) once clinically stable. ⋯ Delirium may still occur after discharge from an ICU in patients who are transferred to an SDU. The strategy of care adopted in the SDU seems to positively affect the recovery from a delirious state. Patients with subsyndromal forms should be promptly recognized and treated because of the risk of developing delirium. Weaning from MV is not hindered by delirium.
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Journal of critical care · Mar 2010
Systemic and bronchoalveolar cytokines as predictors of in-hospital mortality in severe community-acquired pneumonia.
The aim of this study was to determine whether cytokine expression (interleukin [IL]-1beta, IL-6, IL-8, IL-10, and tumor necrosis factor [TNF]-alpha), C-reactive protein, and endotoxins on the first day of intensive care unit (ICU) admission are associated with hospital mortality in severe community-acquired pneumonia (CAP). ⋯ Serum and BAL fluid levels of the studied cytokines on admission may provide valuable prognostic information for patients with severe CAP.