Journal of critical care
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Journal of critical care · Aug 2015
ReviewEarly mobilization in the critical care unit: A review of adult and pediatric literature.
Early mobilization of critically ill patients is beneficial, suggesting that it should be incorporated into daily clinical practice. Early passive, active, and combined progressive mobilizations can be safely initiated in intensive care units (ICUs). Adult patients receiving early mobilization have fewer ventilator-dependent days, shorter ICU and hospital stays, and better functional outcomes. ⋯ Contraindications and perceived barriers to early mobilization, including cost and health care provider views, are identified. Methods of overcoming barriers to early mobilization and enhancing sustainability of mobilization programs are discussed. Optimization of patient outcomes will require further studies on mobilization timing and intensity, particularly within specific ICU populations.
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Journal of critical care · Aug 2015
Comparative StudyComparative evaluation of Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scoring systems in patients admitted to the cardiac intensive care unit.
To assess and compare the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores in the cardiac intensive care unit (CICU). ⋯ Both APACHE II and SOFA scores have good and comparable discriminative ability for predicting outcome. Calibration and accuracy indices are superior for APACHE II.
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Journal of critical care · Aug 2015
Weaning critically ill patients from mechanical ventilation: A prospective cohort study.
A proposal was made at the International Consensus Conference to classify weaning of patients in intensive care units from mechanical ventilation into simple, difficult, and prolonged weaning groups based on the difficulty and length of the weaning process. The objective of the present study was to determine the incidence and outcome of weaning according to these new categories. ⋯ Patients who experienced prolonged weaning had significantly higher mortality rates than patients who experienced either simple or difficult weaning. A lower Glasgow Coma Scale score and hypercapnia at the beginning of the weaning process were independent risk factors for prolonged weaning.
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Journal of critical care · Aug 2015
Development and validation of a clinical prediction rule for candidemia in hospitalized patients with severe sepsis and septic shock.
To develop and internally validate a prediction rule for the presence of candidemia in patients with severe sepsis and septic shock (candidemia rule) that will fill the gap left by previous rules. To compare the accuracy of the available Candida prediction models. ⋯ We developed and internally validated a prediction rule for candidemia in hospitalized patients with severe sepsis and septic shock that outperformed previous prediction rules. Our study suggests that locally derived prediction models may be superior by accounting for local case mix and risk factor distribution.