Journal of critical care
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Journal of critical care · Dec 2015
Postoperative patients in the intensive care unit: Identifying those who do not really need it.
We evaluated severity-scoring systems as predictors of intensive care unit (ICU) need and created a new model for identifying postoperative patients who do not really need ICU. ⋯ The new model can predict LRPs more accurately than each scoring system alone. The care of LRPs in intermediate care units can prevent overuse of ICUs. But the lack of outcome comparison for predicted LRPs in ICUs vs intermediate care units is the most important limitation of our study.
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Journal of critical care · Dec 2015
Clinically suspected heparin-induced thrombocytopenia during extracorporeal membrane oxygenation.
Patients receiving extracorporeal membrane oxygenation (ECMO) are at risk for thrombocytopenia including heparin-induced thrombocytopenia (HIT). The purpose of this study was to determine the frequency of suspected HIT in patients receiving ECMO and unfractionated heparin (UFH). ⋯ The evaluation of HIT occurred in a small percentage of patients, with HIT rarely being detected. Patients who had heparin-platelet factor 4 immunoassay testing exhibited lower platelet counts with a similar duration of ECMO and UFH exposure.
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Journal of critical care · Dec 2015
Revisiting endotracheal self-extubation in the surgical and trauma intensive care unit: Are they all fine?
Endotracheal self-extubation (ESE) is a serious health care concern. We designed this study to test our hypothesis that not all patients with ESE are successful in spontaneous breathing and reintubation has negative impact on outcomes. ⋯ Not all patients were fine after ESE. We have not decreased the frequency of ESE or improved outcomes if the patients were reintubated. The need for reintubation was not only associated with a high pulmonary complication rate but also prolonged duration on mechanical ventilation and hospital/ICU stay and increased the hospital costs.
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Journal of critical care · Dec 2015
Risk factors for discharge on a new antipsychotic medication after admission to an intensive care unit.
Increased awareness of delirium in the intensive care unit (ICU) has led to higher use of antipsychotic medications for treatment of delirium. These medications are often not discontinued at ICU or hospital discharge, which may increase the risk of inappropriate polypharmacy. Our study sought to identify risk factors for being discharged on a new antipsychotic medication after admission to a trauma-surgical ICU or neurocritical care unit. ⋯ Those patients with higher Acute Physiology and Chronic Health Evaluation II scores and more benzodiazepine days are at increased odds of being discharged on a new antipsychotic.
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Journal of critical care · Dec 2015
Epidemiological trends in invasive mechanical ventilation in the United States: A population-based study.
Epidemiological trends for invasive mechanical ventilation (IMV) have not been clearly defined. We sought to define trends for IMV in the United States and assess for disease-specific variation for 3 common causes of respiratory failure: pneumonia, heart failure (HF), and chronic obstructive pulmonary disease (COPD). ⋯ Utilization of IMV in the US increased from 1993 to 2009 with a decrease in overall mortality. However, trends in utilization and outcomes of IMV differed markedly based on diagnosis. Unlike favorable outcome trends in pneumonia and COPD, hospital mortality for HF has not improved. Further studies to investigate the outcome gap between HF and other causes of respiratory failure are needed.