Journal of critical care
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Journal of critical care · Jun 2015
Clinical outcomes associated with high, intermediate, and low rates of failed extubation in an intensive care unit.
Extubation failure is associated with adverse outcomes in mechanically ventilated patients, and it is believed that high rates of failed planned extubation (FPE) should be avoided. However, many believe that very low rates may also correlate with adverse outcomes if resulting from overly conservative weaning practices. We examined the relationship between the percentage of FPE (%FPE) and associated outcomes, with the aim of elucidating a favorable middle range. ⋯ Although exact rates may vary depending on setting, this suggests that a high %FPE (>15) should be avoided in the intensive care unit and that there may be an intermediate range where ventilator outcomes are optimized.
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Journal of critical care · Jun 2015
Observational StudyIntravenous immunoglobulin improves sepsis-induced coagulopathy: A retrospective, single-center observational study.
Inflammation and coagulation are closely interrelated processes in the pathogenesis of sepsis. This study aimed to determine whether intravenous immunoglobulin (IVIg) could improve the hyperinflammatory state and coagulation/fibrinolysis abnormalities in patients with sepsis. ⋯ Intravenous immunoglobulin treatment significantly improved hemostatic abnormalities along with the hyperinflammatory state in patients with sepsis. Accordingly, IVIg treatment should be classified as an adjunctive therapy for patients complicated with sepsis-induced coagulopathy.
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Journal of critical care · Jun 2015
Observational StudyAcute kidney injury in a Malaysian intensive care unit: Assessment of incidence, risk factors, and outcome.
Acute kidney injury (AKI) is common and carries a high mortality rate. Most epidemiological studies were retrospective and were done in Western populations. We aim to assess its incidence using both urine output and creatinine criteria and its association with risk factors and outcome. ⋯ Acute kidney injury is common in our ICU, and almost half are of highest severity stage. Patients with high severity of illness and septic shock were at risk for AKI. The presence of AKI independently predicted mortality.
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Journal of critical care · Jun 2015
Soluble urokinase-type plasminogen activator levels are related to plasma cytokine levels but have low predictive value for mortality in trauma patients.
Soluble urokinase-type plasminogen activator (suPAR) represents a marker for immune activation and has predictive value in critically ill patients. The kinetics of suPAR and its correlation with the immune response and outcome in trauma patients are unknown. ⋯ After trauma, initial suPAR plasma concentrations are higher in nonsurvivors compared with survivors, but its predictive value is low. Soluble urokinase-type plasminogen activator levels increase over time after trauma, and concentrations at later time points are related to cytokine levels at the ED.
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Journal of critical care · Jun 2015
Outcomes and prognostic factors in patients with prolonged acute mechanical ventilation: A single-center study in Korea.
The purpose of the study is to evaluate outcomes and objective parameters related to poor prognosis in patients who were defined as prolonged acute mechanical ventilation (PAMV; ventilator care ≥96 hours) in the medical intensive care unit of a university-affiliated tertiary care hospital in Korea. ⋯ Four clinical factors (body mass index ≤21, requirement for neuromuscular blockers, vasopressors, and hemodialysis) on day 4 of mechanical ventilation were associated with 28-day mortality in PAMV patients.