Journal of critical care
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Journal of critical care · Feb 2014
Randomized Controlled TrialHeparin/N-acetylcysteine: An adjuvant in the management of burn inhalation injury: A study of different doses.
Nebulized heparin may reduce fibrin cast formation and reduce the degree of airway obstruction in burn inhalation injury. ⋯ Nebulized heparin 10,000 IU decreased lung injury scores and duration of mechanical ventilation but had no effect on length of ICU stay and mortality. Moreover, nebulized heparin 10,000 IU was safe and had no effect on coagulation parameters.
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Journal of critical care · Feb 2014
The relationship between lactate and thiamine levels in patients with diabetic ketoacidosis.
Thiamine functions as an important cofactor in aerobic metabolism and thiamine deficiency can contribute to lactic acidosis. Although increased rates of thiamine deficiency have been described in diabetic outpatients, this phenomenon has not been studied in relation to diabetic ketoacidosis (DKA). In the present study, we hypothesize that thiamine deficiency is associated with elevated lactate in patients with DKA. ⋯ Patients with DKA had a high prevalence of thiamine deficiency. Thiamine levels were inversely related to lactate levels among patients with DKA. A study of thiamine supplementation in DKA is warranted.
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Journal of critical care · Feb 2014
Prediction of delirium in critically ill patients with elevated C-reactive protein.
Delirium is thought to be associated with systemic inflammatory response. However, its association with the most widely used inflammatory biomarker C-reactive protein (CRP) has not been well established. We aimed to examine whether CRP on intensive care unit (ICU) entry was associated with subsequent development of delirium. ⋯ C-reactive protein measured on ICU entry and its changes within 24 hours are risk indicators of delirium. Further studies exploring the treatment of delirium according to CRP levels are warranted.
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Journal of critical care · Feb 2014
Intensive care specialists' knowledge, attitudes, and professional use of published research evidence: A mail-out questionnaire survey of appropriate use of research evidence in clinical practice.
This survey investigates the knowledge, attitudes, and use of published research in clinical practice by intensive care specialists. ⋯ Respondents reported generally positive attitudes toward using published research evidence, in clinical practice; however, room for improvement in technical knowledge relating to published research evidence was noted.
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Journal of critical care · Feb 2014
Review Meta AnalysisFluid resuscitation with hydroxyethyl starches in patients with sepsis is associated with an increased incidence of acute kidney injury and use of renal replacement therapy: A systematic review and meta-analysis of the literature.
Fluid resuscitation is a key intervention in sepsis, but the type of fluids used varies widely. The aim of this meta-analysis is to determine whether resuscitation with hydroxyethyl starches (HES) compared with crystalloids affects outcomes in patients with sepsis. ⋯ Fluid resuscitation practice with HES as in the meta-analyzed studies is associated with increased an increase in AKI incidence, need of RRT, RBC transfusion, and 90-day mortality in patients with sepsis. Therefore, we favor the use of crystalloids over HES for resuscitation in patients with sepsis.