Journal of critical care
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Journal of critical care · Feb 2016
Use of probiotics to prevent ventilator-associated pneumonia: A survey of pharmacists' attitudes.
The primary objective of this survey was to describe pharmacists' attitudes regarding probiotic use in the intensive care unit (ICU); secondary objectives were to evaluate pharmacists' knowledge and use of probiotics for critically ill patients. ⋯ Most Canadian ICU pharmacists have used probiotics at least once in the ICU in the last year. However, based on uncertain efficacy and safety, most ICU pharmacists would not currently recommend probiotics for the prevention of ventilator-associated pneumonia.
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Journal of critical care · Feb 2016
Observational StudyNear-infrared spectroscopy to assess microvascular dysfunction: A prospective pilot study in cardiac surgery patients.
The diagnosis of microvascular dysfunction remains challenging after cardiac surgery. We hypothesized that peripheral near-infrared spectroscopy (NIRS) monitoring in combination with a vascular occlusion test could reliably assess postoperative microvascular dysfunction in that setting. ⋯ Peripheral NIRS monitoring in combination with a vascular occlusion test failed to assess cardiopulmonary bypass-induced microvascular dysfunction.
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Journal of critical care · Feb 2016
Observational StudyPrognosis of patients presenting extreme acidosis (pH <7) on admission to intensive care unit.
The purpose was to determine prognosis of patients presenting extreme acidosis (pH <7) on admission to the intensive care unit (ICU) and to identify mortality risk factors. ⋯ Patients with extreme acidosis on admission to ICU have a less severe than expected prognosis. Whereas mortality is almost 100% in cases of cardiac arrest before admission, mortality is much lower in the absence of cardiac arrest before admission, which justifies aggressive ICU therapies.
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Journal of critical care · Feb 2016
Observational StudyAcute respiratory distress syndrome: Predictors of noninvasive ventilation failure and intensive care unit mortality in clinical practice.
Noninvasive ventilation (NIV) is used as an initial ventilatory support in acute respiratory distress syndrome (ARDS), but its utility is unclear, and persistence in those who do not improve may delay intubation and lead to adverse outcomes. Hence, it becomes imperative to have a clear understanding of selecting patients who will benefit from this modality. ⋯ Noninvasive ventilation maybe useful in selected patients with mild ARDS but should be used with great caution in moderate and severe ARDS, as failure risk is high. In addition, low PaO2/FIO2 and shock are associated with NIV failure. Acute Physiology and Chronic Health Evaluation II score, shock, low PaO2/FIO2, and ARDS severity are associated with increased mortality.
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Journal of critical care · Feb 2016
Observational StudyRisk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department.
The purpose was to identify risk factors associated with in-hospital mortality among emergency department (ED) patients with severe sepsis and septic shock managed with early protocolized resuscitation. ⋯ We identified a number of factors that were associated with in-hospital mortality among ED patients with severe sepsis or septic shock despite treatment with early protocolized resuscitation. These findings provide insights into aspects of early sepsis care that can be targets for future intervention.