Journal of critical care
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Journal of critical care · Apr 2011
Delivered dose of continuous venovenous hemofiltration predicts outcome in septic patients with acute kidney injury: a retrospective study.
In continuous venovenous hemofiltration (CVVH) issues like timing and dose remain controversial, particularly in sepsis. The objective of this study is to examine which CVVH characteristic best predicts mortality in sepsis-induced acute kidney injury (AKI). ⋯ Our retrospective data suggest that in sepsis-induced AKI requiring CVVH, delivered dose, rather than timing, mode of administration, and azotemic control, is an independent predictor of mortality. A lower delivered dose is associated with higher mortality.
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Journal of critical care · Apr 2011
Morbidity and mortality characteristics of morbidly obese patients admitted to hospital and intensive care units.
The purpose of this study is to evaluate the outcomes of hospitalized morbidly obese inpatients. ⋯ As BMI increases, utilization of medical resources also increases such as ICU admission, MV, longer hospital LOS, and tracheostomy. Although overall BMI interquartile mortality rates do not differ significantly in our study, utilization of valuable and costly hospital resources is a major challenge facing health care delivery. Our findings indicate the need for increased efforts and novel strategies for treatment, prevention, and resource allocation to deal with this emerging challenge.
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Journal of critical care · Apr 2011
Diazepam as a component of goal-directed sedation in critically ill trauma patients.
Limited information addressing the safety and efficacy of diazepam in the intensive care unit, particularly in trauma patients, is available. The purpose of this study is to evaluate the safety and efficacy of diazepam when used in routine clinical practice as a component of a goal-directed sedation regimen in critically ill trauma patients. ⋯ Based on this limited sample, the use of diazepam as a component of goal-directed therapy appears safe and effective in providing adequate sedation in critically ill trauma patients using an average dosage of 40 mg/d.
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Journal of critical care · Apr 2011
Reduced mortality with noninvasive hemodynamic monitoring of shock.
This study compared clinical outcomes associated with exposure to pulmonary artery catheters (PACs), central venous catheters (CVCs), arterial pressure waveform analysis for cardiac output (APCO), or no central monitoring (NCM) in patients with shock. ⋯ This study supports an association between the use of APCO monitoring and reduction in mortality in shock compared with traditional methods of monitoring. Although it is impossible to exclude the role of unrecognized/unrecorded differences among the groups, these findings may result from differences in supportive care, directed by monitor technology.
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Journal of critical care · Apr 2011
Recall of intensive care unit stay in patients managed with a sedation protocol or a sedation protocol with daily sedative interruption: a pilot study.
Analgesics and sedatives are integral for the relief of pain and anxiety in critically ill patients. However, these agents may contribute to amnesia for intensive care unit (ICU) events; which has been associated with development of posttraumatic stress disorder. Drug administration strategies that minimize sedative use have been associated with less amnesia. The objective of this pilot study was to evaluate recall of ICU stay in patients managed with 2 sedation strategies: a sedation protocol or a combination of sedation protocol and daily sedative/analgesic interruption. ⋯ A notable percentage of patients discharged from the ICU report moderate to extreme pain, anxiety, and fear, and inability to sleep during their ICU stay; and 29% to 48% have no recall of specific ICU events.