Journal of critical care
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyThe value of pretest probability and modified clinical pulmonary infection score to diagnose ventilator-associated pneumonia.
The aim of the study was to assess the utility of pretest probability and modified clinical pulmonary infection score CPIS in the diagnosis of late-onset ventilator-associated pneumonia (VAP). ⋯ Pretest probability and a modified CPIS, which excludes culture results, are of limited utility in the diagnosis of late-onset VAP.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyThe clinical significance of Candida colonization of respiratory tract secretions in critically ill patients.
Clinical uncertainty exists regarding the significance of colonization confined to respiratory tract secretions with Candida sp in critically ill patients. Our objectives were to describe such colonization, its associated risk factors, and to examine the clinical outcomes in patients with a clinical suspicion of ventilator-associated pneumonia with isolated Candida colonization compared to those without. ⋯ Respiratory tract Candida colonization is associated with worse clinical outcomes and is independently associated with increased hospital mortality. However, it is unclear whether Candida colonization is causally related to poor outcomes or whether it is a marker for increased morbidity and mortality.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyUtility of Gram stain in the clinical management of suspected ventilator-associated pneumonia. Secondary analysis of a multicenter randomized trial.
Gram stains of endotracheal aspirates (EA) and bronchoalveolar lavages (BAL) may guide empiric antibiotic therapy in critically ill patients with suspected ventilator-associated pneumonia (VAP). Previous studies differ regarding the ability of the Gram stain to predict final culture results. The aim of the present study was to evaluate the relationship between EA or BAL Gram stains and final culture results in intensive care unit patients with a suspected VAP. ⋯ Gram stains performed for clinically suspected VAP poorly predict the final culture result and thus have a limited role in guiding initial empiric antibiotic therapy in such patients.
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Journal of critical care · Mar 2008
Randomized Controlled Trial Multicenter StudyCorrelates of clinical failure in ventilator-associated pneumonia: insights from a large, randomized trial.
Our objective was to determine clinical variables measured at baseline and day 3 that may relate to failure of resolution of ventilator-associated pneumonia (VAP). ⋯ Clinical characteristics correlate with eventual outcomes in VAP. Failure of the Pao2/Fio2 ratio and fever to improve are independently associated with clinical failure. We suggest that clinicians follow these measures and consider integrating them in their decisions as to when to reevaluate persons with VAP who are not improving.
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Journal of critical care · Dec 2007
Multicenter StudyQuality measurement at intensive care units: which indicators should we use?
This study was conducted to develop a set of indicators that measure the quality of care in intensive care units (ICU) in Dutch hospitals and to evaluate the feasibility of the registration of these indicators. ⋯ In this study, a set of 11 quality indicators for intensive care was defined based on literature research, expert opinion, and testing. The set gives a quick view of the quality of care in individual ICUs. The availability of a computerized data collection system is important for an acceptable workload.