Journal of critical care
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Journal of critical care · Oct 2018
Six subphenotypes in septic shock: Latent class analysis of the PROWESS Shock study.
Septic shock is a highly heterogeneous condition which is part of the challenge in its diagnosis and treatment. In this study we aim to identify clinically relevant subphenotypes of septic shock using a novel statistic al approach. ⋯ LCA appears to be an applicable statistical tool in analysing a heterogenous clinical cohort of septic shock. The results may lead to a better understanding of septic shock complexity and form a basis for considering targeted therapies and selecting patients for future clinical trials.
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Journal of critical care · Oct 2018
Observational StudyPredictive value of serum albumin levels on noradrenaline and fluid requirements in the first 24 h after admission to the Intensive Care Unit - A prospective observational study.
To determine the predictive value of serum albumin (SA) at admission to the intensive care unit (ICU) on the cumulative dose of noradrenaline, the fluids administered, the lactate level, and mortality during the first 24 h of ICU admission. ⋯ SA significantly predicts noradrenaline and fluid requirements as well as the change in lactate level during the first 24 h of ICU admission. Our observations have to be validated in another large cohort.
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Journal of critical care · Oct 2018
Out-of-bed mobilization of patients undergoing mechanical ventilation with orotracheal tubes: A survey study.
The aim of this study is to clarify intensive care unit (ICU)-level factors facilitating out-of-bed mobilization defined as a range of activities from sitting on edge of bed up to walking in mechanically ventilated patients with orotracheal tubes. ⋯ Based on impression of professionals, the presence of dedicated therapist in the ICU, and the high intensity physician staffing are significantly associated with an increased rate of out-of-bed mobilization for mechanically ventilated patients with orotracheal tubes.
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Journal of critical care · Oct 2018
National incidence rates for Acute Respiratory Distress Syndrome (ARDS) and ARDS cause-specific factors in the United States (2006-2014).
To estimate the incidence of Acute Respiratory Distress Syndrome (ARDS) and ARDS-related mortality rates. ⋯ Although increasing incidence for ARDS was observed, mortality rates declined for most risk factors. Mortality for transfusion and trauma-associated ARDS increased in the later study period, research is needed to examine reasons for the increasing in-hospital deaths associated with these risk factors.
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Journal of critical care · Oct 2018
Accidental dual humidification in intensive care units: Repeated alerts and system changes are not enough.
The inadvertent, simultaneous use of heat and moisture exchangers (HMEs) and heated humidifiers (HHs) can result in waterlogging of the filter and sudden ventilation tube occlusion, with potentially fatal consequences. Following an NHS England Safety Alert, a near miss and educational reminders in our institution, we introduced new guidelines to solely use HHs in the intensive care unit and HMEs only for patient transfers. No further incidents have occurred, however this solution is potentially fallible. Two years later, we sought to assess staff knowledge and likelihood of recognising this error should it occur. ⋯ Despite educational efforts and system changes, recognition of this error remained poor. System changes may reduce the likelihood of the error occurring, but when it does, recognition may not occur. Substantial reductions or elimination of this error may be achieved through a safety-engineered fail-safe within the equipment, which alerts staff to improve recognition and prevent the mistake.