Journal of critical care
-
Journal of critical care · Oct 2013
Previous antibiotic exposure and evolution of antibiotic resistance in mechanically ventilated patients with nosocomial infections.
This study aimed to evaluate the impact of previous antibiotic exposure and the influence of time interval since exposure on the evolution of antibiotic-resistant infections. ⋯ Although antibiotic exposure increased resistance rate in nosocomial infections, this association decreased as time interval increased. Antibiotic stewardship should consider the significance of time interval while investigating the evolution of subsequent antibiotic-resistant infections.
-
Journal of critical care · Oct 2013
Changing trends in the use of seizure prophylaxis after traumatic brain injury: A shift from phenytoin to levetiracetam.
Current guidelines for traumatic brain injury (TBI) recommend antiepileptic drugs (AEDs) for 7 days after injury to decrease posttraumatic seizure risk. Phenytoin decreases seizure risk 73% vs placebo during this time. Levetiracetam (LEV) is an alternative; however, no published data validate comparable efficacy. Our objective was to evaluate seizure incidence 7 days after TBI in patients treated with phenytoin (PHT) vs LEV and to characterize practice of AED selection. ⋯ Only 2 patients experienced posttraumatic seizure after receiving AED, indicating low incidence. Most surviving to hospital discharge received AED prophylaxis greater than 7 days despite guideline recommendations. After approval of intravenous LEV, a trend favoring LEV was observed.
-
Journal of critical care · Oct 2013
Hypophosphatemia on the intensive care unit: Individualized phosphate replacement based on serum levels and distribution volume.
Hypophosphatemia occurs in about 25% of patients admitted to the intensive care unit. To date, a safe and validated phosphate replacement protocol is not available. ⋯ This study shows that phosphate replacement with dose calculation based on serum phosphate levels and a Vd of 0.5 L/kg is effective and safe.
-
Journal of critical care · Oct 2013
High glucose variability increases cerebral infarction in patients with spontaneous subarachnoid hemorrhage.
High glucose variability is a significant marker for poor outcome in critically ill patients. We evaluated the impact of high glucose variability on cerebral infarction following spontaneous subarachnoid hemorrhage (SAH). ⋯ Glucose variability is a significant predictor of cerebral infarction in patients with severe spontaneous SAH.
-
Journal of critical care · Oct 2013
Use of venovenous extracorporeal membrane oxygenation in central airway obstruction to facilitate interventions leading to definitive airway security.
Extracorporeal membrane oxygenation (ECMO) is useful for providing hypoxic patients with ventilatory support, but its usefulness in the management of patients with central airway obstruction has rarely been reported. Nineteen cases in one center where venovenous (VV) ECMO was used to support patients with severe central airway obstruction while they underwent lifesaving interventions are reported here. ⋯ Venovenous ECMO may be useful in patients with central airway obstruction because it provides short-term airway security while lifesaving procedures are being performed.