Journal of critical care
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Journal of critical care · Oct 2019
ReviewClinical controversies in abdominal sepsis. Insights for critical care settings.
Sepsis is a deadly condition in which the outcome is associated with prompt and adequate recognition, intensive supportive care, antibiotic administration and source control. This last item makes abdominal sepsis a unique treatment challenge. Although pneumonia constitutes the leading cause of sepsis, abdominal sepsis has unique features that merit discussion. ⋯ The epidemiology of abdominal sepsis and its outcomes are difficult to assess due to the large clinical heterogeneity associated with this entity. Further complicating issues is the debate surrounding the effect of early source control (i.e. the "surgeon effect"). This review evaluates and summarizes the current approach to current challenges in patient care and which are the future research directions.
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Journal of critical care · Oct 2019
Randomized Controlled Trial Multicenter Study Comparative StudyAnalgesia-first sedation in critically ill adults: A U.S. pilot, randomized controlled trial.
To determine the feasibility of conducting a multicenter ICU RCT of AFS compared to either protocol-directed sedation (PDS) or both PDS and daily sedation interruption (DSI) in North America. ⋯ A multicenter RCT evaluating AFS is feasible to conduct in North America.
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Journal of critical care · Oct 2019
Multicenter StudyImpact of triage-to-admission time on patient outcome in European intensive care units: A prospective, multi-national study.
Ubiquitous bed shortages lead to delays in intensive care unit (ICU) admissions worldwide. Assessing the impact of delayed admission must account for illness severity. This study examined both the relationship between triage-to-admission time and 28-day mortality and the impact of controlling for Simplified Acute Physiology Score (SAPS) II scores on that relationship. ⋯ Even after accounting for quantifiable parameters of illness severity, delayed admission did not negatively impact outcome. Triage practices likely influence outcomes. Severity scores may not fully reflect illness acuity or trajectory.
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Journal of critical care · Oct 2019
Observational StudyOptimal norepinephrine-equivalent dose to initiate epinephrine in patients with septic shock.
The specific norepinephrine dose at which epinephrine should be added in septic shock is unclear. This study sought to determine the norepinephrine-equivalent dose at epinephrine initiation that correlated with hemodynamic stability. ⋯ Initiation of epinephrine when patients were receiving norepinephrine-equivalent doses of 37-133 μg/min was associated with a higher rate of hemodynamic stability.