Journal of critical care
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Journal of critical care · Dec 2015
The introduction of basic critical care echocardiography reduces the use of diagnostic echocardiography in the intensive care unit.
Basic critical care echocardiography (CCE) is routinely used by intensive care unit (ICU) providers to rapidly address key hemodynamic questions for the critically ill. By comparison, diagnostic echocardiography (DE) uses a comprehensive examination with more traditional workflow and sophisticated techniques. Despite these differences, both are frequently used to answer similar questions in ICU. This overlap raises questions of duplicate testing and redundancy of hospital resources. We therefore evaluated the effect of the introduction of basic CCE over the use of DE in Victoria Hospital, a tertiary care ICU in London Ontario, Canada. ⋯ In a hospital with a significant increase in basic CCE use, an associated significant decrease in DE use was observed with no increase in adverse outcomes. The significant increase in basic CCE use resulted in a change of management in most cases including the request for DE in a minority of cases.
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Journal of critical care · Dec 2015
Randomized Controlled Trial Multicenter StudyImpact of endotracheal intubation on septic shock outcome: A post hoc analysis of the SEPSISPAM trial.
The objective of the study to is to determine the characteristics associated with endotracheal intubation in septic shock patients. ⋯ Practices regarding the place of endotracheal intubation in septic shock may impact outcome.
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Journal of critical care · Dec 2015
Modeling for critically ill patients: An introduction for beginners.
Models are mathematical tools used to describe real-world features. Therapeutic interventions in the field of critical care medicine may easily be translated into such models. Indeed, numerous variables influencing drug pharmacokinetics and pharmacodynamics are systematically documented in the intensive care unit over time. ⋯ Modeling in the critically ill may allow physicians to inform decisions related to therapeutic interventions, particularly relating to infectious diseases. However, few clinicians are familiar with these methods. Here, we present a current overview of population pharmacokinetic and pharmacodynamic models applicable in critically ill patients aimed at nonspecialists and then emphazize recent potential of modeling for optimizing treatments and care in the intensive care unit.
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Journal of critical care · Dec 2015
ReviewMechanistic similarities between trauma, atherosclerosis, and other inflammatory processes.
Most human diseases, including trauma, atherosclerosis, and malignancy, can be characterized by either an overexuberant inflammatory response or an inadequate immunologic response. As our understanding of the mechanisms underlying these inflammatory aberrations improves, so should our approach to the patient. ⋯ Trauma surgeons are uniquely positioned to usher in a new era of patient diagnostics and patient-directed therapies based on an understanding of the immune system's response to stimuli. These improvements are likely to affect not only trauma care but all aspects of medicine.
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Journal of critical care · Dec 2015
Admission hyperglycemia is associated with poor outcome after emergent coronary bypass grafting surgery.
Hyperglycemia during or after cardiac surgery is a common finding that is associated with poor outcome. Very few data, however, are available regarding a correlation between admission blood glucose and outcomes after coronary artery bypass grafting (CABG). Thus, the goal of the current study was to examine the relationship between admission blood glucose and outcome after emergency CABG surgery. ⋯ Our study shows for the first time that admission blood glucose is correlated with increased morbidity and mortality among patients undergoing emergency CABG surgery.