Journal of critical care
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Journal of critical care · Dec 2016
ReviewThe role of central venous oxygen saturation, blood lactate, and central venous-to-arterial carbon dioxide partial pressure difference as a goal and prognosis of sepsis treatment.
The current practice in treatment of severe sepsis and septic shock is to ensure adequate oxygenation and perfusion in patients, along with prompt administration of antibiotics, within 6 hours from diagnosis, which is considered the "golden hour" for the patients. One of the goals of treatment is to restore normal tissue perfusion. With this goal in mind, some parameters have been used to determine the success of treatment and mortality rate; however, none has been proven to be the best predictor of mortality rate in sepsis patients. Despite growing evidence regarding the prognostic indicators for mortality in sepsis patients, inconsistent reports exist. ⋯ There is currently no ideal biomarker that can indicate prognosis, predict progression of the disease, and guide treatment in sepsis. Further studies are needed to be carried out to identify the ideal biomarker that has all the desired properties.
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Journal of critical care · Dec 2016
Randomized Controlled TrialA 4-arm randomized controlled pilot trial of innovative solutions for jugular central venous access device securement in 221 cardiac surgical patients.
To improve jugular central venous access device (CVAD) securement, prevent CVAD failure (composite: dislodgement, occlusion, breakage, local or bloodstream infection), and assess subsequent trial feasibility. ⋯ Jugular CVAD securement is challenging in postcardiac surgical patients who are coagulopathic and mobilized early. TA+SPU was ineffective for CVAD securement and is not recommended. Suture + TA+SPU appeared promising, with zero CVAD failure observed. Future trials should resolve uncertainty about the comparative effect of suture + TA+SPU, suture + AD, and SSD+SPU vs suture + BPU.
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Journal of critical care · Dec 2016
ReviewRecirculation in venovenous extracorporeal membrane oxygenation.
Despite the increasing use of venovenous extracorporeal membrane oxygenation (ECMO) to treat severe respiratory failure, recirculation remains a common complication that may result in severe hypoxemia and end-organ damage. The present review, therefore, examines updated evidence for the causes, measurement, and management of recirculation. Six electronic databases were searched from their dates of inception to January 2016, and 38 relevant studies were selected for analysis. ⋯ Although cannula configuration appears to be a key contributor to recirculation in addition to factors such as ECMO flow rate, there are insufficient comparative clinical studies to recommend an optimal cannulation technique for minimizing recirculation. Existing evidence suggests that the dual-lumen cannula may have a low recirculation fraction, but only if correctly positioned. This review underscores the need for more robust clinical and laboratory studies to effectively evaluate and address the persistent problem of recirculation.
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Journal of critical care · Dec 2016
Observational StudyInter-hospital transfer is associated with increased mortality and costs in severe sepsis and septic shock: An instrumental variables approach.
The objective of this study was to evaluate the impact of regionalization on sepsis survival, to describe the role of inter-hospital transfer in rural sepsis care, and to measure the cost of inter-hospital transfer in a predominantly rural state. ⋯ The majority of rural sepsis patients are transferred, and these transferred patients have higher mortality and significantly increased cost of care.
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Journal of critical care · Dec 2016
Randomized Controlled TrialEvaluation of a critical care outreach service in a middle-income country: A stepped wedge cluster randomized trial and nested qualitative study.
This trial evaluates implementation of critical care outreach in a middle-income country. ⋯ This pragmatic evaluation of critical care outreach in a middle-income country did not show a reduction in mortality or other outcomes.