Journal of critical care
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Journal of critical care · Apr 2019
Non-clinical delays in transfer out of the surgical ICU are associated with increased hospital length of stay and delayed progress of care.
The impact of non-clinical transfer delay (TD) from the ICU to a general care unit on the progress of the patient's care is unknown. We measured the association between TD and: (1) the patient's subsequent hospital length of stay (LOS); (2) the timing of care decisions that would advance patient care. ⋯ TD is associated with longer LOS and delays in milestone clinical decisions that progress care. Eliminating delays in milestones could mitigate TD's impact on LOS.
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Journal of critical care · Apr 2019
Review Meta Analysis Comparative StudyCrystalloids vs. colloids for fluid resuscitation in the Intensive Care Unit: A systematic review and meta-analysis.
Guidelines recommend crystalloids for fluid resuscitation in sepsis/shock and switching to albumin in cases where crystalloids are insufficient. We evaluated hemodynamic response to crystalloids/colloids in critically ill adults. ⋯ Crystalloids were less efficient than colloids at stabilizing resuscitation endpoints; guidance on when to switch is urgently required.
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Journal of critical care · Apr 2019
Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit.
To assess trends in life support interventions and performance of the automated Acute Physiology and Chronic Health Evaluation (APACHE) IV model at mortality prediction compared with Oxford Acute Severity of Illness Score (OASIS) in a contemporary cardiac intensive care unit (CICU). ⋯ Contemporary CICU patients are increasingly ill, observed in upward trends in comorbid conditions and life support interventions. APACHE IV predicted death and OASIS showed good discrimination in predicting death in this population. APACHE IV and OASIS may be useful for benchmarking and quality improvement initiatives in the CICU, the former having better discrimination.
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Journal of critical care · Apr 2019
Review Meta AnalysisRenal resistive index as predictor of acute kidney injury after major surgery: A systematic review and meta-analysis.
To determine the efficacy of Doppler renal resistive index in the prediction of acute kidney injury after major surgery. ⋯ Renal resistive index represents a useful marker with fair performance in the prediction of postoperative acute kidney injury. Future cohorts should establish the optimal timing of measurement and evaluate the most appropriate cut-off value that should be used in the clinical setting.