Journal of critical care
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Journal of critical care · Feb 2015
Incidence, risk factors, and outcome of transfusion-related acute lung injury in critically ill children: A retrospective study.
Acute lung injury (ALI) that develops within 6 hours after transfusion (TRALI) is the leading cause of transfusion-related morbidity and mortality. Both incidence and patient and transfusion-related risk factors are well studied in the adult critically ill patient population. Clinical data on TRALI in the pediatric population are sparse and are mainly limited to case reports and hemovigilance reporting systems. The objective of this study was to determine incidence, risk factors, and outcome of TRALI in critically ill children. ⋯ Transfusion-related ALI is relatively common in critically ill children. The incidence in the pediatric intensive care unit population is similar to that in adult intensive care unit patients. High PRISM score on admission, mechanical ventilation and sepsis were identified as independent risk factors, which may help to assess the risks and benefits of transfusion in critically ill patients.
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Journal of critical care · Feb 2015
Experience with a hospital policy on not offering cardiopulmonary resuscitation when believed more harmful than beneficial.
This study investigated the impact of age, race, and functional status on decisions not to offer cardiopulmonary resuscitation (CPR) despite patient or surrogate requests that CPR be performed. ⋯ There was no association between age, race, or functional status and the decision not to offer CPR made in consultation with an ethics committee. Orders to withhold CPR were more common among critically ill patients.
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Journal of critical care · Feb 2015
Intensive care unit and hospital mortality in patients with obstructive sleep apnea.
Obstructive sleep apnea (OSA) is a common disorder affecting between 5% and 24% of men and women. The prevalence of OSA in the intensive care unit (ICU) population is unknown. This study was undertaken to determine the prevalence of OSA in patients admitted to the ICU and to determine if OSA is an independent predictor of mortality. ⋯ Obstructive sleep apnea is common in patients admitted to the ICU. Obstructive sleep apnea was associated with a reduction in both ICU and hospital mortality.
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Journal of critical care · Feb 2015
Medical and neurologic complications of the current management strategy of angiographically negative nontraumatic subarachnoid hemorrhage patients.
Common management of angionegative subarachnoid hemorrhage includes mandatory intensive care unit stay for up to 14 days with strict bedrest, constant neurologic serial examination, invasive arterial and central line monitoring, and aneurysm rupture precautions. We evaluated the frequency of neurologic and nonneurologic complications in this patient population. ⋯ Based on our results, we propose admission to the medical floor for patients with World Federation of Neurosurgical Societies score 1 to 3, perimesencephalic CT pattern, and no hydrocephalus.
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Journal of critical care · Feb 2015
Observational StudyThe utility of microalbuminuria measurements in pediatric burn injuries in critical care.
Microalbuminuria, as measured by urinary albumin-creatinine ratios (ACRs), has been shown to be a marker of systemic inflammation and an indicator of the potential severity of trauma and critical illness. Severe pediatric burns represent the best model in which to investigate the clinical utility of microalbuminuria. This study aims to ascertain whether ACR measurements have any role in predicting the severity or the intensive care requirements in the critically unwell pediatric burn population. ⋯ The clinical utilities of ACR measurements are demonstrated by their correlation with the severity of injury, length of ICU stay, and requirements for multiple organ support. Albumin-creatinine ratios raised over certain thresholds highlight to the clinician the need for closer observation and the potential deterioration of patients.