Journal of critical care
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Journal of critical care · Jun 2017
Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
Using administrative codes and minimal physiologic and laboratory data, we sought a high-specificity identification strategy for patients whose sepsis initially appeared during their ICU stay. ⋯ Selected administrative codes coupled to SIRS criteria and applied to patients admitted to ICU can yield up to 94% authentic sepsis patients. However, only 1/3 of patients thus identified appeared to become septic during their ICU stay. Studies that depend on high-intensity monitoring for description of the time course of sepsis require clinician review and verification that sepsis initially appeared during the monitoring period.
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Journal of critical care · Jun 2017
Observational StudyCarotid systolic flow time with passive leg raise correlates with fluid status changes in patients undergoing dialysis.
Corrected carotid systolic flow time (CFTc) has been proposed as a measure of volume status in acutely ill patients. This study endeavors to determine whether the change in CFTc with passive leg raise (PLR) maneuver correlates with volume status changes. Dialysis patients at Kingston General Hospital (Kingston, Canada) underwent point-of-care carotid ultrasonography at the beginning and the end of dialysis. ⋯ Particularly, in our sample of patients, a 30milliseconds increase in CFTc with PLR predicted the post-dialysis volume state (LR+=11) whereas an increase of less than 20milliseconds argued against it (LR-=0.079). The assessment of CFTc pre- and post-PLR correlates with intravascular volume changes in patients undergoing dialysis. Alternative to the currently available bedside modalities, this technique is non-invasive, objective, simple to perform at the bedside, and reversible with respect to volume challenge.
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Journal of critical care · Jun 2017
Cytokine profiles as novel diagnostic markers of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis in children.
The aim of this study was to identify specific laboratory indices to distinguish Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) in children. ⋯ This study showed that IFN-γ, IL-10/IL-6, and IFN-γ/IL-6 are novel specific indicators for differential diagnosis of EBV-HLH. Additionally, IL-6, IL-10, TNF-α, and IFN-γ are useful indices for monitoring the effects of treatment on EBV-HLH.
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Journal of critical care · Jun 2017
Monitoring sound and light continuously in an intensive care unit patient room: A pilot study.
To determine the feasibility of continuous recording of sound and light in the intensive care unit (ICU). ⋯ Combined sound and light can be continuously and easily monitored in the ICU setting. Incorporating sound and light monitors in ICU rooms may promote an enhanced patient- and staff-centered healing environment.
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Journal of critical care · Jun 2017
Brain death after decompressive craniectomy: Incidence and pathophysiological mechanisms.
Patients who received decompressive craniectomy (DC) are usually not regarded to qualify for brain death (BD) as intracranial pressure (ICP) is not assumed to reach levels critical enough to cause cerebral perfusion failure. Here we investigated the incidence of BD after DC and analyzed the pathophysiological mechanisms. ⋯ Our study evidences that DC does not exclude BD. Even after DC, BD is preceded by a severely reduced CPP, supporting loss of cerebral perfusion as a critical step in BD pathophysiology.