Journal of critical care
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Journal of critical care · Aug 2012
Comparative StudyComparison of Predisposition, Insult/Infection, Response, and Organ dysfunction, Acute Physiology And Chronic Health Evaluation II, and Mortality in Emergency Department Sepsis in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle.
The aim of the study was to examine the performance of the Predisposition, Insult/Infection, Response, and Organ dysfunction (PIRO) model compared with the Acute Physiology and Chronic Health Evaluation (APACHE) II and Mortality in Emergency Department Sepsis (MEDS) scoring systems in predicting in-hospital mortality for patients presenting to the emergency department (ED) with severe sepsis or septic shock. ⋯ The PIRO, APACHE II, and MEDS have variable abilities to early discriminate and estimate in-hospital mortality of patients presenting to the ED meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle. The PIRO may provide additional risk stratification in patients with APACHE II 25 or more. More studies are required to evaluate the clinical applicability of PIRO in high-risk patients with severe sepsis and septic shock.
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Journal of critical care · Aug 2012
Comparative StudyEffect of 24-hour mandatory vs on-demand critical care specialist presence on long-term survival and quality of life of critically ill patients in the intensive care unit of a teaching hospital.
Mandatory compared with on-demand intensivist presence improves processes of care and decreases intensive care unit (ICU) complication rate and hospital length of stay. The effect of continuous mandatory intensivist coverage on long-term patient mortality and quality of life (QOL) is not known. ⋯ Introduction of an additional night shift to provide mandatory as opposed to on-demand 24-hour staff critical care specialist coverage did not affect long-term survival of medical ICU patients.
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Journal of critical care · Aug 2012
What is the best method for estimating the burden of severe sepsis in the United States?
The aim of the study was to compare estimates of hospitalizations, outcomes, and costs produced by 2 approaches for defining severe sepsis. ⋯ An approach that requires a diagnosis code for septicemia and a diagnosis code for organ dysfunction yields estimates of disease burden and outcomes that are more consistent with chart-based studies.
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Journal of critical care · Aug 2012
The effect of body position changes on stroke volume variation in 66 mechanically ventilated patients with sepsis.
The aim of the study was to investigate the effect of body position changes on the stroke volume (SI) variation (SVV) in ventilated patients with sepsis. ⋯ Body position changes may affect the correlation of SVV with hemodynamic variables. The 30° head-up and prone positions increased SVV because of the associated decreased SV. The 30° left or right recumbent position does not affect SVV and SV.
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Journal of critical care · Aug 2012
Perceived benefit of a telemedicine consultative service in a highly staffed intensive care unit.
The aim of this study was to evaluate whether a nocturnal telemedicine service improves culture, staff satisfaction, and perceptions of quality of care in a highly staffed university critical care system. ⋯ Telemedicine has the potential to improve staff satisfaction and communication in highly staffed ICUs.