Journal of critical care
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Journal of critical care · Jun 2020
ReviewTreating sepsis with vitamin C, thiamine, and hydrocortisone: Exploring the quest for the magic elixir.
The administration of ascorbic acid (vitamin C) alone or in combination with thiamine (vitamin B1) and corticosteroids (VCTS) has recently been hypothesized to improve hemodynamics, end-organ function, and may even increase survival in critically ill patients. There are several clinical studies that have investigated the use of vitamin C alone or VCTS in patients with sepsis and septic shock or are ongoing. Some of these studies have demonstrated its safety and potential benefit in septic patients. ⋯ These questions exist because the bulk of research regarding the efficacy of vitamin C alone or in combination with thiamine and corticosteroids in sepsis is limited to a few randomized controlled trials, retrospective before-and-after studies, and case reports. Thus, although the underlying rationale and mechanistic pathways of vitamin C and thiamine in sepsis have been well described, the clinical impact of the VCTS regimen is complex and remains to be determined. This review aims to explore the current evidence and potential benefits and adverse effects of the VCTS regimen for the treatment of sepsis.
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Journal of critical care · Jun 2020
Integrating a safety smart list into the electronic health record decreases intensive care unit length of stay and cost.
To measure how an integrated smartlist developed for critically ill patients would change intensive care units (ICUs) length of stay (LOS), mortality, and charges. ⋯ An integrated smart list shortened LOS and lowered charges in a diverse cohort of critically ill patients.
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Journal of critical care · Jun 2020
Multicenter Study Observational StudyA new simplified and accurate sa-SOFA score.
Several remarks have been raised regarding the variables and cut-points used in the Sequential Organ Failure Assessment (SOFA) score. This study revisited the SOFA score and created a new simplified and accurate sa-SOFA score. ⋯ Keeping the conventional SOFA dimension variables, the new sa-SOFA proved to be simpler and more accurate in predicting 28-day mortality.
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Journal of critical care · Jun 2020
Multicenter Study Observational StudyRelationship between norepinephrine dose, tachycardia and outcome in septic shock: A multicentre evaluation.
Septic shock is associated with massive release of endogenous catecholamines. Adrenergic agents may exacerbate catecholamine toxicity and contribute to poor outcomes. We sought to determine whether an association existed between tachycardia and mortality in septic shock patients requiring norepinephrine for more than 6 h despite adequate volume resuscitation. ⋯ Use of high-dose norepinephrine and concurrent tachycardia are associated with poor outcomes in septic shock.
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Journal of critical care · Jun 2020
Multicenter StudyAbnormal shock index exposure and clinical outcomes among critically ill patients: A retrospective cohort analysis.
To assess the predictive value of a single abnormal shock index reading (SI ≥0.9; heart rate/systolic blood pressure [SBP]) for mortality, and association between cumulative abnormal SI exposure and mortality/morbidity. ⋯ A single SI reading ≥0.9 is a poor predictor of mortality; cumulative SI exposure is associated with greater risk of mortality/morbidity. The associations with in-hospital mortality were comparable for SI ≥0.9 or SBP ≤100-mmHg exposure. Dynamic interactions between hemodynamic variables need further evaluation among critically ill patients.