Journal of critical care
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Journal of critical care · Apr 2017
Increased incidence of clinical hypotension with etomidate compared to ketamine for intubation in septic patients: A propensity matched analysis.
This study compared the incidence of clinical hypotension between ketamine and etomidate within a 24 hour period following endotracheal intubation. ⋯ Ketamine was associated with a lower incidence of clinical hypotension within the 24 hour period following endotracheal intubation in septic patients.
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Journal of critical care · Apr 2017
Development and validation of the new ICNARC model for prediction of acute hospital mortality in adult critical care.
To develop and validate an improved risk model to predict acute hospital mortality for admissions to adult critical care units in the UK. ⋯ The risk model developed in this study showed excellent discrimination and calibration and when validated on a different period of time and across different types of critical care unit. This in turn allows improved accuracy of comparisons between UK critical care providers.
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Journal of critical care · Apr 2017
Comparative StudyHigher glucose variability in type 1 than in type 2 diabetes patients admitted to the intensive care unit: A retrospective cohort study.
Although the course of disease of type 1 and type 2 diabetes differs, the distinction is rarely made when patients are admitted to the intensive care unit (ICU). Here, we report patient- and admission-related characteristics in relation to glycemic measures of patients with type 1 and type 2 diabetes admitted to the ICU. ⋯ Patients with type 1 diabetes showed a higher glucose variability, but overall glycemic control was not different between patients with type 1 and type 2 diabetes. Very few diabetes patients admitted to the ICU have type 1 diabetes.
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Journal of critical care · Apr 2017
Clinical utility of methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction assay in critically ill patients with nosocomial pneumonia.
This study investigated the diagnostic performance characteristics of a methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) assay in critically ill patients with nosocomial pneumonia. ⋯ In critically ill patients, an MRSA nasal PCR assay has a high NPV for nosocomial pneumonia and can be used to guide vancomycin de-escalation.
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Journal of critical care · Apr 2017
Practice GuidelineEvidence-based guidelines for the use of tracheostomy in critically ill patients.
To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. ⋯ Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.