Journal of critical care
-
Journal of critical care · Feb 2019
Observational StudyUse of biomarkers in the prediction of culture-proven infection in the surgical intensive care unit.
The purpose of this study was to prospectively analyze the predictive role of classic predictors for suspected infection (temperature, WBC and derivatives) with two biomarkers, procalcitonin and lactate, on the incidence of culture-proven infection in the surgical intensive care unit (SICU). ⋯ The ability to utilize procalcitonin values in the diagnosis of culture-proven infection was not realized in this study. However, the association of admission peak procalcitonin values with admission peak lactate values identified a group of patients who were culture-negative for suspected infection. No other admission predictor was associated with culture-proven infection.
-
Journal of critical care · Feb 2019
Observational StudyRapid response team review of hemodynamically unstable ward patients: The accuracy of cardiac index assessment.
Intensive care doctors commonly attend rapid response team (RRT) reviews of hospital-ward patients with hemodynamic instability and estimate the patient's likely cardiac index (CI). We aimed to non-invasively measure the CI of such patients and assess the level of agreement between such measurements and clinically estimated CI categories (low <2L/min/m2, normal 2-2.99L/min/m2 or high ≥3L/min/m2). ⋯ Non-invasive CI measurement was possible in almost all hospital-ward patients triggering RRT review for hemodynamic instability. In such patients, the CI was high, and intensive care clinicians were unable to identify a low or a high CI state.
-
Journal of critical care · Feb 2019
Extracorporeal membrane oxygenation in Korea - Trends and impact of hospital volume on outcome: Analysis of national insurance data 2009-2014.
ECMO use has increased lately. However, differences between adult ECMO and non-ECMO patients admitted to the ICU remain unstudied. In terms of volume-outcome relationship, the impact of ECMO volume on survival has not been validated in a real world cohort. ⋯ The prevalence of ECMO among ICU patients was 0.5%. The expenditure and in-hospital mortality of the ECMO group were four and five times higher than non-ECMO group respectively. An annual hospital ECMO volume ≥ 20 may improve survival to hospital discharge.
-
Journal of critical care · Feb 2019
Comparative StudyImpact of chronic hypertension on time to goal mean arterial pressure and clinical outcomes in critically ill patients with septic shock requiring vasopressors.
Mean arterial pressure (MAP) reflects the adequacy of tissue perfusion. In septic shock, vasopressors are recommended to target MAP ≥65 mmHg. The impact of chronic hypertension (HTN) on MAP achievement and outcomes are uncertain. ⋯ Patients with HTN achieved goal MAP more rapidly but had higher odds of mortality.
-
Journal of critical care · Feb 2019
Validation of diagnostic gene sets to identify critically ill patients with sepsis.
Gene expression diagnostics have been proposed to identify critically ill patients with sepsis. Three expression-based scores have been developed, but have not been compared in a prospective validation. We sought to validate these scores using an independent dataset and analysis. ⋯ All three scores distinguished septic from non-septic ICU patients, with the SMS showing the best performance overall in our cohort. Our results suggest that models developed from the co-analysis of multiple cohorts are more generalizable. Further work is needed to identify expression-based biomarkers of response to specific therapies.