Journal of critical care
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Journal of critical care · Oct 2013
The current state of fellowship training in pulmonary artery catheter placement and data interpretation: A national survey of pulmonary and critical care fellowship program directors.
Given decreasing use of pulmonary artery (PA) catheterization, we sought to evaluate whether current pulmonary and critical care fellows have adequate opportunity to obtain proficiency in PA catheter placement and data interpretation. ⋯ Many current pulmonary and critical care fellows do not have the opportunity to gain proficiency in PA catheterization. Fellowship training programs should consider alternate means of training fellows in PA catheter data interpretation, such as simulation.
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Journal of critical care · Oct 2013
Evaluation of a vancomycin dosing nomogram based on the Modification of Diet in Renal Disease equation in intensive care unit patients.
The purpose of the study is to evaluate the effectiveness of a vancomycin nomogram using actual body weight and the Modification of Diet in Renal Disease equation to estimate renal function in intensive care unit patients. ⋯ Use of a vancomycin nomogram increased the percentage of initial vancomycin trough concentrations 15 μg/mL or higher in intensive care unit patients and was not associated with an increased occurrence of nephrotoxicity.
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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.
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Journal of critical care · Oct 2013
Early lactate clearance in septic patients with elevated lactate levels admitted from the emergency department to intensive care: Time to aim higher?
Septic patients with hyperlactatemia have increased mortality rates, irrespective of hemodynamic and oxygen-derived variables. The aims of the study are the following: (1) to ascertain whether lactate clearance (LC) (percentage change in lactate over unit time) predicts mortality in septic patients admitted to intensive care directly from the emergency department and (2) to calculate the optimal "cut-off" value for mortality prediction. ⋯ Six-hour LC was independently associated with mortality, and the optimal cut-off value was 36%, significantly higher than previously reported. We would support further research investigating this higher LC as a distinct resuscitation end point in patients with severe sepsis and septic shock.
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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.