Journal of critical care
-
Journal of critical care · Jun 2012
Randomized Controlled Trial Multicenter StudyFluid Resuscitation with 5% albumin versus Normal Saline in Early Septic Shock: a pilot randomized, controlled trial.
Randomized, controlled trials of fluid resuscitation in early septic shock face many logistic challenges. We describe the Fluid Resuscitation with 5% albumin versus Normal Saline in Early Septic Shock (PRECISE) pilot trial study design and report feasibility of patient recruitment. ⋯ Patient recruitment into the PRECISE pilot trial met our prespecified feasibility targets, and the PRECISE team is planning the larger trial.
-
Journal of critical care · Jun 2012
Multicenter StudyRisk factors for underuse of lung-protective ventilation in acute lung injury.
We assessed factors associated with underuse of lung-protective ventilation (LPV) in patients with acute lung injury (ALI). ⋯ Simple interventions could substantially improve adherence with LPV among patients with ALI and warrant prospective study.
-
Journal of critical care · Jun 2012
Multicenter StudyThe adequacy of timely empiric antibiotic therapy for ventilator-associated pneumonia: an important determinant of outcome.
The individual impact of timeliness vs adequacy of empiric antibiotic therapy for a clinical suspicion of ventilator-associated pneumonia (CSVAP) is unknown. Accordingly, in patients with CSVAP and timely initiation of empiric antibiotic therapy, we determined the impact of inadequate therapy (IT). ⋯ In the context of early administration of empiric broad spectrum antibiotics for CSVAP, IT is associated with higher morbidity and mortality.
-
Journal of critical care · Jun 2012
Multicenter StudyClinical factors associated with initiation of renal replacement therapy in critically ill patients with acute kidney injury-a prospective multicenter observational study.
Our objective was to describe the current practice for initiation of RRT in this population. There is uncertainty regarding the optimal time to initiate renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI). ⋯ In ICU patients requiring RRT, there was marked variation in factors that influence start of RRT. RRT initiation with fewer clinical triggers was associated with lower mortality. Timing of RRT may modify survival but requires appraisal in a randomized trial.
-
Journal of critical care · Jun 2012
Multicenter StudyEpidemiology and management of atrial fibrillation in medical and noncardiac surgical adult intensive care unit patients.
The aim of the study was to describe the epidemiology and management of atrial fibrillation (AF) in noncardiac surgery critically ill patients in a retrospective, observational study at 3 mixed medical-surgical, university-affiliated intensive care units (ICUs). ⋯ Atrial fibrillation is common but transient in most ICU patients. Electrical cardioversion is often unsuccessful, and pharmacologic rhythm conversion is often only transiently effective. Modifiable risk factors are common among these patients. Future studies are needed to address the management of AF in the ICU.