Journal of critical care
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Journal of critical care · Apr 2015
Reevaluation of the utilization of arterial blood gas analysis in the Intensive Care Unit: Effects on patient safety and patient outcome.
Arterial blood gas (ABG) analysis is a useful tool to evaluate hypercapnia in the context of conditions and diseases affecting the lungs. Oftentimes, indications for ABG analysis are broad and nonspecific and lead to frequent testing without test results influencing patient management. ⋯ A significant decrease of ABGs obtained in the ICU does not negatively impact patient outcome and safety. A decrease in the number of ABGs per patient allows cost-efficient patient care with a lower risk for complications.
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Journal of critical care · Apr 2015
Multicenter StudyMulticenter evaluation of pharmacologic management and outcomes associated with severe resistant alcohol withdrawal.
A subset of patients with alcohol withdrawal syndrome does not respond to benzodiazepine treatment despite escalating doses. Resistant alcohol withdrawal (RAW) is associated with higher incidences of mechanical ventilation and nosocomial pneumonia and longer intensive care unit (ICU) stay. The objective of this study is to characterize pharmacologic management of RAW and outcomes. ⋯ Diverse patterns exist in the management of patients meeting RAW criteria, indicating lack of refined approach to treatment. High doses of sedatives used for these patients may result in a high level of care, illustrating a need for evidence-based clinical guidelines to optimize outcomes.
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Journal of critical care · Apr 2015
Observational StudyPredictive value of the complement system for sepsis-induced disseminated intravascular coagulation in septic patients in emergency department.
To investigate changes in circulating complement component C3, membrane attack complex (MAC), and mannose-binding lectin (MBL) in patients with sepsis-induced disseminated intravascular coagulation (DIC). ⋯ Complement 3, MAC, and MBL were significantly increased in septic patients with DIC. Membrane attack complex independently predicted sepsis-induced DIC and development of DIC after ED admission.
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Journal of critical care · Apr 2015
Randomized Controlled Trial Multicenter StudyInsulin infusion therapy in critical care patients: Regular insulin vs short-acting insulin. A prospective, crossover, randomized, multicenter blind study.
The aim of this multicenter, prospective, randomized, crossover trial is to compare, in critical care patients receiving insulin infusion therapy (IIT), the pharmacodynamic of Humulin insulin (Hlin), currently used as "standard of care," and Humalog insulin (Hlog), a shorter acting insulin formulation. This was measured as extent and duration of the carryover effect of insulin treatment, with the latter calculated as ratio between blood glucose concentration (BGC) reduction during and after IIT. ⋯ The use of constant Hlog infusion for IIT, when compared with Hlin at the same dose, is associated with a less profound carryover effect on BGC after discontinuation of IIT, a briefer duration of carryover, a faster BGC drop during infusion, and a quicker BGC rise after discontinuation. These characteristics suggest that Hlog IIT may be preferable for use in critically ill patients.
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Journal of critical care · Apr 2015
A web-based survey of United Kingdom sedation practice in the intensive care unit.
The purpose of this work was to obtain a detailed perspective of sedation practice. Sedation included sedative and opioid choice, presence of local guidelines, and use of scoring systems. ⋯ This survey confirmed expected variation in UK sedation practice. Recognized strategies such as target sedation score and sedation policy are underused. A 43% uptake in delirium screening suggests that larger engagement is required to meet national standards.