Journal of critical care
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Journal of critical care · Aug 2012
Comparative StudyCaution when using prognostic models: a prospective comparison of 3 recent prognostic models.
Prognostic models have been developed to estimate mortality and to compare outcomes in different intensive care units. However, these models need to be validated before their use in different populations. In this study, we assessed the performance of 3 recently developed general prognostic models (Acute Physiologic and Chronic Health Evaluation [APACHE] IV, Simplified Acute Physiology Score [SAPS] 3 and Mortality Probability Model III [MPM(0)-III]) in a population admitted at 3 medical-surgical Brazilian intensive care units. ⋯ In this study, all models showed poor calibration, while discrimination was very good for all of them. As this has been a common finding in validation studies, caution is warranted when using prognostic models for benchmarking.
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Journal of critical care · Aug 2012
Serial changes in adiponectin and resistin in critically ill patients with sepsis: associations with sepsis phase, severity, and circulating cytokine levels.
The aim of the present study was to describe the variation in adiponectin and resistin levels, 2 adipokines with opposing effects on metabolism, in mechanically ventilated patients with sepsis and their relationships to disease severity and cytokine levels. ⋯ Adiponectin and resistin change reciprocally during the course of sepsis. Resistin relates to the severity of sepsis and the degree of inflammatory response. Adiponectin and resistin may play a critical role in the metabolic adaptations observed in sepsis.
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Journal of critical care · Aug 2012
Extravascular lung water indexed or not to predicted body weight is a predictor of mortality in septic shock patients.
The purpose was to investigate whether extravascular lung water (EVLW) indexed to actual body weight (EVLWa) is an independent predictor of mortality in patients with septic shock, to determine the relationship between EVLWa and other markers of lung injury, and to test if indexing EVLW with predicted body weight (EVLWp) strengthens its predictive power. ⋯ Extravascular lung water indexed or not to predicted body weight is an independent predictor of mortality in patients with septic shock. Repeated measurements of EVLW indexes over time, rather than a too-early measurement, seem to be more appropriate for predicting outcome.
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Journal of critical care · Aug 2012
Variation in the care of septic shock: the impact of patient and hospital characteristics.
The aim of this study was to examine treatments of septic shock in a sample of US hospitals and to assess whether patient and hospital characteristics are associated with use of sepsis therapies. ⋯ Treatment of septic shock varies across hospitals. In contrast to mechanical ventilation, treatments with weaker supporting evidence showed greater variation, especially among black and older patients.
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Journal of critical care · Aug 2012
Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the Modified Early Warning Score.
Clear and detectable signs of deterioration have been shown to be present in many patients multiple hours before undergoing a serious life-threatening event. To date, few studies are available describing normal practice and the possible effectiveness of structured tools regarding recognition of deteriorating patients. The aim of this study was to describe the current practice in measurement and documentation of vital signs and the possible usefulness of the Modified Early Warning Score (MEWS) to identify deteriorating patients on hospital wards. ⋯ Two hundred four patients were included. In the 48 hours before the event, a total of 2688 measurements of one or more vital signs were taken. Overall, 81% of the patients had an MEWS value of 3 or more at least once during the 48 hours before their event. Recordings of vital signs were mostly incomplete. Even when the MEWS was 3 or more, respiratory rate, diuresis, and oxygen saturation were documented in only 30% to 66% of assessments.