Journal of critical care
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Journal of critical care · Oct 2019
Comparative StudyValidation the performance of New York Sepsis Severity Score compared with Sepsis Severity Score in predicting hospital mortality among sepsis patients.
The aim of this study was to compare the performance of the New York Sepsis Severity Score (NYSSS) with the Sepsis Severity Score (SSS) and Acute Physiology and Chronic Health Evaluation and Simplified Acute Physiology Scores for predicting mortality in sepsis patients. ⋯ The SSS had better discrimination and overall performance than the NYSSS. However, both sepsis severity scores were poorly calibrated.
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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 StudyVariability in triage practices for critically ill cancer patients: A randomized controlled trial.
Intensive care triage practices and end-user interpretation of triage guidelines have rarely been assessed. We evaluated agreement between providers on the prioritization of patients for ICU admission using different triage guidelines. ⋯ The low agreement amongst practitioners on the prioritization of cancer patient cases for ICU admission existed using both general triage guidelines and guidelines tailored only to cancer patients. The lack of consensus on intensive care unit triage practices in the oncological population exposes a potential barrier to appropriate resource allocation that needs to be addressed.
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Journal of critical care · Oct 2019
Randomized Controlled TrialAeration changes induced by high flow nasal cannula are more homogeneous than those generated by non-invasive ventilation in healthy subjects.
Non-invasive mechanical ventilation (NIV) is a standard respiratory support technique used in intensive care units. High-Flow Nasal Cannula (HFNC) has emerged as an alternative, but further evidence is needed. The lung aeration and diaphragm changes achieved with these two strategies in healthy subjects have not been compared to date. ⋯ NIV and HFNC increased EELI in healthy subjects, suggesting an increase in the functional residual capacity. The EELI increase may be higher in NIV, but HFNC produced a more homogeneous change in lung ventilation. HFNC group has a higher MAR-index that could reflect a different ventilatory system adaptation.
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Journal of critical care · Oct 2019
Randomized Controlled TrialIncreasing support by nasal high flow acutely modifies the ROX index in hypoxemic patients: A physiologic study.
The ROX (Respiratory rate-OXygenation) index is an early predictor of failure of nasal high flow (NHF), with lower values indicating higher risk of intubation. We measured the ROX index at set flow rate of 30 and 60 l/min in 57 hypoxemic patients on NHF. ⋯ The ROX index variation between flows was correlated with the change in end expiratory lung volume. Set flow rate during NHF might impact the ROX index value.