Journal of critical care
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Journal of critical care · Oct 2013
Acute respiratory distress syndrome: Underrecognition by clinicians.
Previous reports suggest that acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is underdiagnosed in both adult and pediatric clinical practice. Underrecognition of this condition may be a barrier to instituting a low tidal volume ventilation strategy. This study aimed to determine the accuracy of clinical diagnoses of ARDS in daily practice using the American European Consensus Conference (AECC) criteria as a criterion standard and to investigate whether clinical recognition of ARDS altered ventilator management. ⋯ Acute respiratory distress syndrome is underrecognized by clinicians in ICU, and recognition does not result in lower tidal volume ventilation. Significant barriers remain to the recognition of ALI/ARDS and application of an evidence-based ventilator strategy.
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Journal of critical care · Oct 2013
Evaluation of hemostatic biomarker abnormalities that precede platelet count decline in critically ill patients with sepsis.
The hemostatic biomarkers for early diagnosis of sepsis-associated coagulopathy have not been identified. The purpose of this study was to evaluate hemostatic biomarker abnormalities preceding a decrease in platelet count, which is a surrogate indicator of overt coagulopathy in sepsis. ⋯ Decreased PC and α2-PI activity preceded a decrease in platelet count in intensive care unit patients with sepsis.
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Journal of critical care · Oct 2013
Augmented renal clearance is a common finding with worse clinical outcome in critically ill patients receiving antimicrobial therapy.
We describe incidence and patient factors associated with augmented renal clearance (ARC) in adult intensive care unit (ICU) patients. ⋯ ARC was documented in approximately 52% of a mixed ICU patient population receiving antibiotic treatment with worse clinical outcome. Young age and male gender were independently associated with ARC presence.
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Journal of critical care · Oct 2013
Evaluation of glucose variability when converting from insulin infusion to basal-bolus regimen in a surgical-trauma intensive care unit.
This study aimed to identify predictive factors resulting in glucose values greater than 200 mg/dL in patients with trauma transitioned from an insulin infusion to a basal-bolus subcutaneous insulin regimen. ⋯ Older patients with trauma and patients with higher blood glucose on admission are more likely to experience severe hyperglycemia when transitioned to basal-bolus glucose control. Higher insulin infusion rates at 48 hours before transition are also associated with severe hyperglycemia.
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Journal of critical care · Oct 2013
Is vitamin D deficiency associated with development of Acinetobacter baumannii infections in critically ill patients?
A growing number of evidence demonstrates deficiency of vitamin D in critically ill patients. We aimed to evaluate the vitamin D status of our critically ill patients and its relevance to infections in these patients. ⋯ Vitamin D deficiency is common in critically ill patients. Even though there was no statistical difference between vitamin D deficient and sufficient patients regarding development of infections in general, A baumannii infections were significantly more frequent in the deficient group. Vitamin D deficiency was found as one of the independent risk factors for A baumannii infections. Further multicenter studies with a larger sample size are required to validate our data.