Journal of critical care
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Journal of critical care · Jun 2008
Multicenter StudyAssessing organizational performance in intensive care units: a French experience.
The objective of the study was to assess and to explain variation of organizational performance in intensive care units (ICUs). ⋯ A benchmarking approach can be used by ICU managers to assess the organizational performance of their ICU based on a validated questionnaire. Differences are mainly explained by cultural values and individual well-being factors, introducing new requirements for managing human resources in ICUs.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyDeterminants of outcome in patients with a clinical suspicion of ventilator-associated pneumonia.
In the absence of a reference standard, a probabilistic approach to the diagnosis of ventilator-associated pneumonia (VAP) has been proposed; and clinician judgment augmented by microbiological tests is used to guide therapy for patients having a clinical suspicion of VAP (CSVAP). However, the correlation of both clinician judgment at the time of CSVAP and the probability of VAP with clinical outcomes is unknown. In a cohort of patients with CSVAP, we sought to determine the correlation of clinician judgment and the probability of VAP with clinical outcomes. In addition, we studied the impact of the clinical and microbiological components of CSVAP on the processes of care and outcomes. ⋯ In patients with CSVAP, clinician judgment as to the probability of VAP does not correlate with processes of care and outcomes; and its use to group patients into those with and without VAP is of limited clinical utility.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyThe safety of targeted antibiotic therapy for ventilator-associated pneumonia: a multicenter observational study.
The aim of this study was to determine the safety of targeted antibiotic therapy (TT) in ventilator-associated pneumonia (VAP). ⋯ Targeted therapy is associated with less antibiotic use and no evidence of harm in the management of patients with VAP.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyPrevious cultures are not clinically useful for guiding empiric antibiotics in suspected ventilator-associated pneumonia: secondary analysis from a randomized trial.
To examine the predictive validity of prior cultures at predicting the microorganism isolated at the time of suspicion of ventilator-associated pneumonia (VAP). ⋯ There is poor agreement between prior cultures and cultures performed at time of suspicion of VAP. Prior cultures should not be used to narrow the spectrum of empiric antibiotics.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyVentilator-associated pneumonia caused by multidrug-resistant organisms or Pseudomonas aeruginosa: prevalence, incidence, risk factors, and outcomes.
The aim of this study was to clarify the prevalence and incidence of, risk factors for, and outcomes from suspected ventilator-associated pneumonia (VAP) associated with the isolation of either Pseudomonas or multidrug-resistant (MDR) bacteria ("high risk" pathogens) from respiratory secretions. ⋯ In this patient population, the incidence of high-risk organisms newly acquired during an ICU stay is low. However, the presence of high risk pathogens is associated with worse clinical outcomes.