Journal of critical care
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Journal of critical care · Jun 2019
Diastolic pressure should be used to guide management of patients in shock: PRO.
Based primarily on the rational that adequate diastolic pressure is needed to maintain sufficient coronary blood for myocardial needs, diastolic pressure has been proposed as a treatment target for patients in shock. To date, clinical evidence supporting this is limited to observational data. ⋯ Targeting diastolic pressure can lead to over use of vasopressors, which studies have associated with worse outcome. Pressor management in shock should include assessment of indicators of tissue perfusion and changes in flow if possible.
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Journal of critical care · Jun 2019
Review Meta AnalysisWorldwide variation in Pseudomonas associated ventilator associated pneumonia. A meta-regression.
The objective here is to define the extent and possible reasons for geographic variation in Pseudomonas aeruginosa associated with Ventilator Associated Pneumonia (VAP). ⋯ Pseudomonas associated VAP incidence among reports from six geographic regions worldwide varies by less than twofold with some decline by year of publication. Trauma ICU admission is a significant factor underlying variations in incidence of VAP overall but not Pseudomonas associated VAP.
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Journal of critical care · Jun 2019
Observational StudyA worldwide perspective of sepsis epidemiology and survival according to age: Observational data from the ICON audit.
To investigate age-related differences in outcomes of critically ill patients with sepsis around the world. ⋯ The odds for death in ICU patients with sepsis increased with age with the maximal rate of increase occurring between the ages of 71 and 77 years.
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Journal of critical care · Jun 2019
Sodium bicarbonate therapy for critically ill patients with metabolic acidosis: A scoping and a systematic review.
We aimed to assess the biochemical and physiological effects, clinical efficacy, and safety, of intravenous NaHCO3 therapy in critically ill patients with acute metabolic acidosis. ⋯ Given the lack of data on the effects of intravenous NaHCO3 therapy to support its clinical use and the frequency of bicarbonate therapy, a program of investigation appears justified.
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Journal of critical care · Jun 2019
Physical impairment and perceived general health preceding critical illness is predictive of survival.
We hypothesized that item response based assessment of physical reserve preceding ICU admission is a predictor of survival. ⋯ Physical reserve as assessed by ALDS and perceived general health, preceding ICU admission is predictive of mortality. Obtaining patient's physical reserve or pre-existing perceived general health should be part of routine assessment whether a patient may benefit from ICU admission.