Journal of critical care
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Journal of critical care · Apr 2017
Coagulation in acutely ill patients with severe chronic liver disease: Insights from thromboelastography.
There is controversy about the true coagulation state of acutely ill patients with chronic liver disease (CLD) due to simultaneous pro- and anticoagulant factor deficits and limitations of conventional coagulation tests (CCTs). Thromboelastography (TEG) may provide more physiologically relevant insights. ⋯ In acutely ill patients with CLD, TEG demonstrates delayed clot formation and weaker thrombus strength despite decreased clot lysis. This challenges the notion that such patients experience a balanced coagulation state, highlighting the complexity of their coagulopathies.
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Journal of critical care · Apr 2017
Observational StudyAssociation between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury.
In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury. ⋯ In a cohort of brain-injured patients the development of ARDS was not common. Driving pressure was associated with the development of this disease.
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Journal of critical care · Apr 2017
Sepsis as 2 problems: Identifying sepsis at admission and predicting onset in the hospital using an electronic medical record-based acuity score.
Early identification and treatment improve outcomes for patients with sepsis. Current screening tools are limited. We present a new approach, recognizing that sepsis patients comprise 2 distinct and unequal populations: patients with sepsis present on admission (85%) and patients who develop sepsis in the hospital (15%) with mortality rates of 12% and 35%, respectively. ⋯ This approach yields good to excellent discriminatory performance among adult inpatients for predicting sepsis present on admission or developed within the hospital and may aid in the timely delivery of care.
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Journal of critical care · Apr 2017
Cardiac troponin T is an important predictor of mortality after cardiac surgery.
Serum troponin (cTnT) levels, a commonly measured biomarker of myocardial injury, has rarely been considered in risk models after cardiac surgery. ⋯ We demonstrate that in patients without preoperative myocardial ischemia, the demonstration of myocardial injury (>0.6 ng/mL) in the postoperative period is highly predictive of in-hospital death.
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Journal of critical care · Apr 2017
Observational StudyEffect of daily use of electronic checklist on physical rehabilitation consultations in critically ill patients.
In intensive care unit (ICU) practice, great emphasis is placed on the functional stabilization of the major organ systems, sometimes at the expense of physical rehabilitation. Checklists have shown to be an effective tool for standardizing care models. Our aim was to the study the effect of the use of an electronic checklist on occupational therapy/physical therapy (OT-PT) consults in critically ill patients. ⋯ The use of the electronic checklist in the ICU was associated with increased number of the OT-PT consults.