Journal of critical care
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Journal of critical care · Dec 2012
Use of mechanical ventilation protocols in intensive care units: a survey of current practice.
Mechanical ventilation protocols for treating intensive care unit (ICU) patients are often recommended to improve process of care and outcomes, but their composition may be variable and penetration into clinical practice may be incomplete. We sought to ascertain ICU and hospital characteristics associated with adoption of mechanical ventilation (MV) protocols in Ontario, Canada. ⋯ Most surveyed hospitals reported the presence of a protocol for MV, but only half of these incorporated low tidal volume ventilation. Several organizational factors were associated with adoption of protocols, and therefore, these should also be considered when evaluating the impact of protocols on clinical outcomes.
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Journal of critical care · Dec 2012
Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury.
The definition of "early" in terms of continuous renal replacement therapy (CRRT) initiation has not been uniformly used. Therefore, we tried to elucidate whether the timing of CRRT application, based on the interval between the start time of vasopressors infusion and CRRT initiation, was an independent predictor of mortality in the patients with septic acute kidney injury (AKI). ⋯ This retrospective cohort study suggests that early initiation of CRRT may be of benefit. Given the complex nature of this intervention, the ongoing controversies regarding early vs late initiation of therapy in acute and chronic situation, there is an urgent need to develop well-designed clinical trials to answer the question definitely.
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Journal of critical care · Dec 2012
Prognostic factors in critically ill patients with hematologic malignancies admitted to the intensive care unit.
Despite an improvement in the prognosis of patients with hematologic malignancies, the mortality of such patients transferred to the intensive care unit (ICU) is high. This study determined the predictors of mortality in a cohort of critically ill patients with hematologic malignancies admitted to the ICU. ⋯ Higher mortality in patients with hematologic malignancies admitted to the ICU is associated with more severe illness, as reflected by higher organ failure scores or respiratory or hemodynamic instability. Mortality is higher in patients with acute leukemia as compared with other hematologic malignancies.
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Journal of critical care · Dec 2012
Prognostic factors and outcomes of patients with pulmonary hypertension admitted to the intensive care unit.
Patients with pulmonary hypertension (PH) can decompensate to the point where they require care in the intensive care unit (ICU). Our objective is to examine the outcomes and characteristics of patients with PH admitted to the ICU. ⋯ Mortality is high in critically ill patients with PH. The identification of prognostic baseline characteristics and interventions in the ICU is important and warrants further investigation.
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Journal of critical care · Dec 2012
Predicting in-hospital mortality among critically ill patients with end-stage liver disease.
Critically-ill patients with end-stage liver disease (ESLD) are at high risk for death during intensive care unit hospitalization, and currently available prognostic models have limited accuracy in this population. We aimed to identify variables associated with in-hospital mortality among critically ill ESLD patients and to develop and validate a simple, parsimonious model for bedside use. ⋯ In critically ill ESLD patients, a parsimonious model including only MELD and mechanical ventilation is more accurate than APACHE II alone for predicting in-hospital mortality. This simple bedside model can provide clinicians and patients with valuable prognostic information for medical decision-making.