Journal of critical care
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Journal of critical care · Dec 2019
Sepsis quality in safety-net hospitals: An analysis of Medicare's SEP-1 performance measure.
Newly enacted policies at the state and federal level in the United States require acute care hospitals to engage in sepsis quality improvement. However, responding to these policies requires considerable resources and may disproportionately burden safety-net hospitals. To better understand this issue, we analyzed the relationship between hospital safety-net status and performance on Medicare's SEP-1 quality measure. ⋯ Existing sepsis policies may harm safety-net hospitals and widen health disparities. Our findings suggest that strategies to promote collaboration among hospitals may be an avenue for sepsis performance improvement in safety-net hospitals.
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Journal of critical care · Dec 2019
Hemodynamic profiles following digoxin use in patients with sepsis in the ICU.
To explore the impact of digoxin on hemodynamic parameters in patients with sepsis and tachycardia admitted to the intensive care unit. ⋯ Early digoxin administration in patients with sepsis and tachycardia is uncommon but associated with improvements of hemodynamic parameters. These preliminary results will help formulate future hypotheses for focused trials on utility, efficacy and safety of digoxin in sepsis.
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Journal of critical care · Dec 2019
Hemodynamic decompensation in normotensive patients admitted to the ICU with pulmonary embolism.
Many normotensive patients with acute pulmonary embolism (PE) are admitted to an intensive care unit (ICU) to monitor for hemodynamic decompensation. We investigated the incidence and causes of early hemodynamic decompensation in normotensive patients admitted to an ICU with PE. ⋯ Among patients admitted to the ICU with acute normotensive PE, early hemodynamic decompensation was rare. In patients who experienced decompensation, major bleeding and thrombotic complications were equally likely to have been the precipitant- highlighting the risks of diagnostic anchoring in this population. As our results suggest that ICU-level care may not be necessary for many of these patients, additional tools are needed to assist in the triage of normotensive patients with PE.
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Journal of critical care · Dec 2019
A pilot study of a novel molecular host response assay to diagnose infection in patients after high-risk gastro-intestinal surgery.
SeptiCyte LAB measures the expression of four host-response RNAs in peripheral blood to distinguish sepsis from sterile inflammation. This study evaluates whether sequential monitoring of this assay has diagnostic utility in patients after esophageal surgery. ⋯ Sequential measurement of SeptiCyte LAB may have diagnostic value in the monitoring of surgical patients at high risk of postoperative infection, but its clinical performance in this setting needs to be validated.
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Journal of critical care · Dec 2019
Acute critically ill elderly patients: What about long term caregiver burden?
Acute critical illness induce a high caregivers burden in the young population, however data in the older population are lacking. The objectives of this study were to evaluate caregiver burden in a critically ill old population and to assess factors associated with mild to severe burden level. ⋯ In our study, functional status and mental health at 6 months were associated with mild to severe burden unlike age and admission in ICU.