Journal of critical care
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Journal of critical care · Oct 2018
Multicenter StudyDiagnosis, management, and prognosis of patients with acute kidney injury in Japanese intensive care units: The JAKID study.
To determine the proportion of diagnosis and outcomes of critically ill patients with acute kidney injury (AKI), and its association with mortality using the complete Kidney Disease Improving Global Outcomes (KDIGO) classification and Sepsis-3 definition. ⋯ AKI accounted for >40% of ICU patients with the KDIGO classification and was associated with increased risk of hospital mortality. Septic AKI was diagnosed in three-fourths of patients with sepsis, while the impact of AKI on hospital mortality among sepsis was not observed.
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Journal of critical care · Oct 2018
Multicenter Study Observational StudySafety incidents in airway and mechanical ventilation in Spanish ICUs: The IVeMVA study.
To assess incidence, related factors and characteristics of safety incidents associated with the whole process of airway management and mechanical ventilation (MV) in Spanish ICUs. ⋯ MV is a risk process in critical patients. Although most incidents did not harm patients, some caused damage and a few were related to the patient's death or permanent damage. Preventability is high.
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Journal of critical care · Oct 2018
Multicenter StudyDetection of invasive pulmonary aspergillosis in critically ill patients by combined use of conventional culture, galactomannan, 1-3-beta-D-glucan and Aspergillus specific nested polymerase chain reaction in a prospective pilot study.
Invasive pulmonary aspergillosis (IPA) is an emerging and life-threatening infectious disease in patients admitted to the intensive care unit (ICU). Most diagnostic studies are conducted in hematological patients and results cannot readily be transferred to ICU patients lacking classical host factors. In a multicenter, prospective clinical trial including 44 ICU patients, hematological (n = 14) and non-hematological patients (n = 30), concurrent serum and bronchoalveolar lavage (BAL) samples were analyzed by conventional culture, galactomannan (GM), 1-3-beta-D-glucan (BDG) as well as an Aspergillus specific nested polymerase chain reaction (PCR). ⋯ Whereas mean GM levels were significantly higher in hematological patients BDG and PCR did not differ between hematological and non-hematological patients. Under present clinical conditions test combinations integrating both BAL and blood samples are advantageous. BDG might best serve as possible indicator for ruling out IPA.
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Journal of critical care · Aug 2018
Multicenter Study Observational StudyFactors associated with delayed rapid response team activation.
Delayed activation of the rapid response team (RRT) is common and has been associated with adverse outcomes. However, little is known about the factors associated with delayed activation. This was an observational study from two hospitals in Ottawa, Canada, including adult inpatients with experiencing an activation of the RRT. ⋯ The reasons for RRT call were significantly different (P < 0.001) with respiratory distress (29.3% versus 24.8%), and hypotension (17.4% versus 13.2%) being more common in the delayed group, and dysrhythmias (15.9% versus 18.5%) and altered level of consciousness (13.5% versus 18.7%) being less common. RRT activation was more delayed on non-surgical services (P < 0.001). Delayed activation was associated with increased mortality (Adjusted odds ratio [OR] 1.23, 95% CI 1.07-1.41), ICU admission (Adjusted OR 1.72, 95% CI 1.51-1.96), and hospital length of stay (13 versus 15 days, P < 0.001).
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Journal of critical care · Aug 2018
Multicenter StudyLate organ failures in patients with prolonged intensive care unit stays.
The purpose of this study was to characterize the organ failures that develop among patients with prolonged ICU stays, defined as those who spent a minimum of 14 days in an ICU. ⋯ Strategies aiming to reduce the development of new late organ failures may be a novel target for preventing persistent critical illness.