Journal of critical care
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Journal of critical care · Aug 2014
Case ReportsA practical approach to neurologic evaluation in the intensive care unit.
Delirium and neurologic impairment are extremely common in the intensive care setting, and their delayed identification is an important contributor to patient morbidity. Even in comatose patients, the clinical neurologic examination remains the most accurate and effective tool in assessing nervous system function. ⋯ The purpose of this tutorial is to discuss techniques of neurologic examination and localization with an emphasis on comatose patients. Commonly encountered cases of encephalopathy and coma along with clinical pearls are presented.
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Journal of critical care · Aug 2014
Observational StudyAdministration of proton pump inhibitors in critically ill medical patients is associated with increased risk of developing Clostridium difficile-associated diarrhea.
Proton pump inhibitors (PPIs) effectively prevent gastrointestinal bleedings in critically ill patients at the intensive care unit (ICU). In non-ICU hospitalized patients, PPI administration increases the risk of infectious complications, especially Clostridium difficile-associated diarrhea (CDAD); but no such data are available for the ICU setting. ⋯ Proton pump inhibitor therapy was an independent risk factor for CDAD in medical ICU patients. Instead of routine PPI use for bleeding prophylaxis, further trials should investigate risk-adjusted algorithms, balancing benefits, and threats of PPI medication.
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Journal of critical care · Aug 2014
Observational StudyCorrelation of corrected flow time in the carotid artery with changes in intravascular volume status.
Assessment of volume status remains a challenge in critical care. Our purpose was to determine if Doppler waveform analysis of carotid artery blood flow correlates with changes in volume status. ⋯ Intravenous fluid administration in dehydrated patients resulted in significant changes in FTc in the carotid artery despite no change in vital signs. Corrected flow time measured from carotid arterial blood flow may be a useful means of assessing volume status in volume-depleted patients.
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Journal of critical care · Aug 2014
Immature granulocytes predict microbial infection and its adverse sequelae in the intensive care unit.
We evaluated the predictive value of immature granulocyte (IG) percentage in comparison with white blood cell counts (WBC) and C-reactive protein (CRP), for infection, its invasiveness, and severity in critically ill patients. ⋯ Immature granulocyte percentage is a useful marker, as CRP, to predict infection, its invasiveness, and severity, in critically ill patients. However, the IG percentage adds to WBC and CRP in the early exclusion of infection and can be obtained routinely without extra blood sampling or costs.
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Journal of critical care · Aug 2014
Observational StudyIncidence and predictors of new-onset atrial fibrillation in noncardiac intensive care unit patients.
Atrial fibrillation (AF) is thought to be a relatively common arrhythmia in the setting of noncardiac intensive care unit (ICU). However, data concerning AF deriving from such populations are scarce. In addition, it is unclear which of the wide spectrum of AF predictors are relevant to the ICU setting. ⋯ A significant fraction of ICU patients manifest AF. The predictors of interest for the ICU patients might be considerably different than those of the general population and other subgroups with systemic inflammation possibly having a pivotal role.