Journal of critical care
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Journal of critical care · Aug 2011
Randomized Controlled Trial Multicenter Study Comparative StudyThe Toronto prehospital hypertonic resuscitation--head injury and multiorgan dysfunction trial: feasibility study of a randomized controlled trial.
The aim of the study was to evaluate the feasibility of a prehospital trial comparing hypertonic saline and dextran (HSD) with normal saline (NS) in blunt head injury patients. ⋯ It is feasible to conduct a prehospital randomized controlled trial with HSD for treatment of blunt trauma patients with head injuries; however, consent for neurofunctional outcomes in this cohort is problematic and threatens the feasibility of definitive trials using these potentially meaningful end points.
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Journal of critical care · Aug 2011
Multicenter StudyBioavailability of fondaparinux to critically ill patients.
Venous thromboembolism is a common problem in the intensive care unit (ICU). To decrease its incidence, prophylactic pharmacologic interventions are part of the ICU routine. However, common ICU conditions may impair the bioavailability of subcutaneously administered agents. The present study evaluates the bioavailability of prophylactic subcutaneous fondaparinux to critically ill patients. ⋯ Vasopressor therapy does not appear to affect fondaparinux bioavailability or to reduce anti-factor Xa levels. Subtherapeutic concentrations were detected during the first 48 hours of fondaparinux administration in hemodynamically stable patients. The clinical significance of reduced levels during the first 2 days of fondaparinux administration remains unknown.
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Journal of critical care · Aug 2011
Quality of life 9 years after an intensive care unit stay: a long-term outcome study.
The purpose of the study was to assess long-term mortality after an intensive care unit (ICU) stay and to test the hypotheses that (1) quality of life improves over time and (2) predictions of outcome made by caregivers during an ICU stay are reliable. ⋯ Mortality is high 9 years after ICU stay. Quality of life may deteriorate for some individuals; however, overall quality of life for most survivors remains acceptable and may even improve. Long-term outcome predictions made by caregivers during the ICU stay seem accurate.
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Journal of critical care · Aug 2011
Persistent sepsis-induced hypotension without hyperlactatemia: is it really septic shock?
The prognostic value of hyperlactatemia in septic shock is unquestionable. However, as current definitions do not include hyperlactatemia as a mandatory criterion, some hypotensive patients may be diagnosed as having septic shock despite exhibiting normolactatemia. The significance of persistent sepsis-induced hypotension without hyperlactatemia is unclear. Is it really septic shock? Our aim was to determine differences in outcome between patients diagnosed as having septic shock but exhibiting normal vs elevated lactate levels during evolution. We also explored the potential implications of including hyperlactatemia as an obligatory diagnostic criterion. ⋯ Persistent sepsis-induced hypotension without hyperlactatemia may not constitute a real septic shock. Our results support the need to review the current definition of septic shock. Hyperlactatemia could represent an objective parameter worth to be explored as a potential diagnostic criterion for septic shock.
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Journal of critical care · Aug 2011
Comparative StudyComparison of 3 different multianalyte point-of-care devices during clinical routine on a medical intensive care unit.
Multianalyte point-of-care (POC) devices are important to guide clinical decisions in critical care. However, the use of different devices in one hospital might cause problems. Therefore, we evaluated 3 commonly used POC devices and analyzed accuracy, reliability, and bias. ⋯ Although POC devices are of high standard and overall comparability between devices is high, there might be a clinically relevant bias between devices, as found in our study for pO2, BE(B), hemoglobin, and hematocrit. This can be of importance when interpreting results of the same patient obtained from different POC devices, as it could happen when a patient is transferred within a hospital where different devices are used.