Journal of critical care
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Journal of critical care · Feb 2018
Observational StudySepsis mortality score for the prediction of mortality in septic patients.
To derive a prediction equation for 30-day mortality in sepsis using a multi-marker approach and compare its performance to the Sequential Organ Failure Assessment (SOFA) score. ⋯ A sepsis mortality score using baseline leukocytes count, PCT, IL-6 and ARE was derived, which predicted 30-day mortality with very good performance and added significant prognostic information to SOFA score.
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To describe parents' perceived quality of pediatric burn care and evaluate factors associated with differences in perceived quality among parents. ⋯ Parents' perceived quality of care is associated with psychological health, but not with characteristics of the child's injury or age. The results suggest that burn care can improve by involving parents of girls more and by being more attentive towards parents who themselves appear stressed or worried.
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Journal of critical care · Feb 2018
Observational StudyMassive transfusion practice in non-trauma related hemorrhagic shock.
Evidence suggests that trauma patients with hemorrhagic shock requiring massive transfusion have improved outcomes if resuscitated with a prescribed massive transfusion protocol (MTP). However, there is limited data regarding the efficacy of MTP in non-trauma patients. ⋯ Over half of the patients receiving massive transfusion protocols for their non-trauma related hemorrhagic shock survived. Survivors were younger, were less acutely ill, and on non-medical services. Further research is needed to investigate best practice for transfusion in non-trauma related hemorrhagic shock.
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Journal of critical care · Feb 2018
Neutrophil CD64, C-reactive protein, and procalcitonin in the identification of sepsis in the ICU - Post-test probabilities.
We were interested in whether C-reactive protein (CRP) and procalcitonin (PCT) distinguish sepsis from non-septic controls and whether a combination of CRP, PCT, and neutrophil CD64 improves identification of sepsis in the intensive care unit (ICU). ⋯ Neutrophil CD64 expression was superior to PCT and CRP for the identification of sepsis in ICU. Positive post-test probability for any combinations of simultaneously analyzed CRP, PCT and CD64 showed improved diagnostic accuracy for sepsis. This approach may be useful for guiding antibiotic treatment in ICU.
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Journal of critical care · Feb 2018
Clinical management of pressure control ventilation: An algorithmic method of patient ventilatory management to address "forgotten but important variables".
Pressure controlled ventilation is a common mode of ventilation used to manage both adult and pediatric populations. However, there is very little evidence that distinguishes the efficacy of pressure controlled ventilation over that of volume controlled ventilation in the adult population. This gap in the literature may be due to the absence of a consistent and systematic algorithm for managing pressure controlled ventilation. ⋯ This algorithmic approach highlights the need for clinicians to have a comprehensive conceptual understanding of mechanical ventilation, pulmonary physiology, and interpretation of ventilator graphics in order to best care for patients receiving pressure controlled ventilation. The objective of identifying a systematic approach to managing pressure controlled ventilation is to provide a more generalizable and equitable approach to management of the ICU patient. Ideally, a consistent approach to managing pressure controlled ventilation in the adult population will glean more reliable information regarding actual patient outcomes, as well as the efficacy of pressure controlled ventilation when compared to volume controlled ventilation.