Journal of critical care
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Journal of critical care · Aug 2012
Multicenter StudyUS practitioner opinions and prescribing practices regarding corticosteroid therapy for severe sepsis and septic shock.
The aim of this study was to examine opinions and practices of US critical care practitioners (USCCPs) toward corticosteroid therapy in adult patients with severe sepsis or septic shock. ⋯ Corticosteroids are commonly used by USCCPs in adult patients with septic shock; however, criteria used to initiate therapy and opinions regarding their impact vary.
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Journal of critical care · Aug 2012
Comparative StudyComparison of physician prediction with 2 prognostic scoring systems in predicting 2-year mortality after intensive care admission: a linked-data cohort study.
Patients who survive an episode of critical illness continue to experience significant mortality after hospital discharge. This study assessed the accuracy of physician prediction of 2-year mortality and compared it with 2 objective prognostic models. ⋯ Physicians tended to overpredict the risk of 2-year mortality of critically ill patients, but accuracy was comparable with 2 objective prognostic models.
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Journal of critical care · Aug 2012
Comparative StudyStaff satisfaction between 2 models of care for the chronically critically ill.
Chronically critically ill (CCI) patients are a growing population in intensive care units (ICUs), and evidence suggests that this patient group is perceived as demanding by healthcare professionals. However, information is scarce regarding organizational factors that affect staff satisfaction during the care of CCI patients. ⋯ Results from this study provide information about health-care professionals' perceived burden of care when treating CCI patients. Strategies promoting professional development have a potential to increase staff satisfaction when it comes to the care of this patient group.
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Journal of critical care · Aug 2012
Extravascular lung water indexed or not to predicted body weight is a predictor of mortality in septic shock patients.
The purpose was to investigate whether extravascular lung water (EVLW) indexed to actual body weight (EVLWa) is an independent predictor of mortality in patients with septic shock, to determine the relationship between EVLWa and other markers of lung injury, and to test if indexing EVLW with predicted body weight (EVLWp) strengthens its predictive power. ⋯ Extravascular lung water indexed or not to predicted body weight is an independent predictor of mortality in patients with septic shock. Repeated measurements of EVLW indexes over time, rather than a too-early measurement, seem to be more appropriate for predicting outcome.
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Journal of critical care · Aug 2012
Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the Modified Early Warning Score.
Clear and detectable signs of deterioration have been shown to be present in many patients multiple hours before undergoing a serious life-threatening event. To date, few studies are available describing normal practice and the possible effectiveness of structured tools regarding recognition of deteriorating patients. The aim of this study was to describe the current practice in measurement and documentation of vital signs and the possible usefulness of the Modified Early Warning Score (MEWS) to identify deteriorating patients on hospital wards. ⋯ Two hundred four patients were included. In the 48 hours before the event, a total of 2688 measurements of one or more vital signs were taken. Overall, 81% of the patients had an MEWS value of 3 or more at least once during the 48 hours before their event. Recordings of vital signs were mostly incomplete. Even when the MEWS was 3 or more, respiratory rate, diuresis, and oxygen saturation were documented in only 30% to 66% of assessments.