Journal of critical care
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Journal of critical care · Aug 2013
Characterization of the spectrum of hemodynamic profiles in trauma patients with acute neurogenic shock.
Neurogenic shock considered a distributive type of shock secondary to loss of sympathetic outflow to the peripheral vasculature. In this study, we examine the hemodynamic profiles of a series of trauma patients with a diagnosis of neurogenic shock. ⋯ Results from this study suggest that hypotension of neurogenic shock can have multiple mechanistic etiologies and represents a spectrum of hemodynamic profiles. This understanding is important for the treatment decisions in managing these patients.
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Journal of critical care · Aug 2013
The clinical quandary of counseling the moribund critical care patient-a registry analysis of postsurgical outcomes.
To provide outcomes data to intensivists and surgeons for counseling patients and family members when considering a surgical intervention in a moribund patient. ⋯ The moribund patient is not as grave as once thought and surgery on these patients may not be futile given the 47% survival rate at 30 days. Postoperative complication rates are high. The data presented provide a meaningful tool for the clinicians in counseling patients and families on the expectations when considering a surgical intervention for moribund patients.
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Journal of critical care · Aug 2013
Comparative StudyAccuracy of the chest radiograph to identify bilateral pulmonary infiltrates consistent with the diagnosis of acute respiratory distress syndrome using computed tomography as reference standard.
The purpose of the study is to evaluate the diagnostic accuracy of the anteroposterior chest radiograph to detect pulmonary abnormalities consistent with acute respiratory distress syndrome (ARDS). ⋯ The accuracy of the portable chest radiograph to detect pulmonary abnormalities consistent with ARDS is significantly limited. These findings suggest that the use of the chest radiograph results mainly in underrecognition of the syndrome, particularly when disease is not diffusely distributed, but also in overdiagnosis.
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Journal of critical care · Aug 2013
Acinetobacter baumannii infection was decreased by the structural renovation of a medical intensive care unit.
The study aimed to determine whether improvements in intensive care unit (ICU) structural environment affect the incidence of ICU-acquired infections (IAIs), particularly those caused by multidrug-resistant pathogens. ⋯ These results suggest that structural ICU renovations only may not improve overall IAI incidence, except for transient decrease in IAI by A baumannii.
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Journal of critical care · Aug 2013
Urine output is associated with prognosis in patients with acute kidney injury requiring continuous renal replacement therapy.
Although some studies have found that early initiation of continuous renal replacement therapy (CRRT) is associated with better prognosis, no consensus exists on the best timing to start CRRT. We investigated whether the timing of CRRT initiation was relevant to overall mortality and explored which factors at the time of CRRT initiation were associated with better outcomes in critically ill patients with acute kidney injury (AKI). ⋯ Urine output but not BUN concentration was significantly associated with a better prognosis in critically ill patients with AKI requiring CRRT.