Critical care medicine
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Critical care medicine · Apr 2007
Prognostic values of B-type natriuretic peptide in severe sepsis and septic shock.
To investigate the changes in B-type natriuretic peptide concentrations in patients with severe sepsis and septic shock and to investigate the value of B-type natriuretic peptide in predicting intensive care unit outcomes. ⋯ B-type natriuretic peptide concentrations were increased in patients with severe sepsis or septic shock regardless of the presence or absence of cardiac dysfunction. Neither the B-type natriuretic peptide levels for the first 3 days nor the daily changes in B-type natriuretic peptide provided prognostic value for in-hospital mortality and length of stay in this mixed group of patients, which included patients with chronic cardiac dysfunction.
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Critical care medicine · Apr 2007
Multicenter StudyA new risk prediction model for critical care: the Intensive Care National Audit & Research Centre (ICNARC) model.
To develop a new model to improve risk prediction for admissions to adult critical care units in the UK. ⋯ The ICNARC model demonstrated better discrimination and overall fit than existing risk prediction models, even following recalibration of these models. We recommend it be used to replace previously published models for risk adjustment in the UK.
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Critical care medicine · Apr 2007
Multicenter StudyIncidence and prognosis of early hepatic dysfunction in critically ill patients--a prospective multicenter study.
In critically ill patients, hepatic dysfunction is regarded as a late organ failure associated with poor prognosis. We investigated the incidence and prognostic implications of early hepatic dysfunction (serum bilirubin >2 mg/dL within 48 hrs of admission). ⋯ Our results provide strong evidence that early hepatic dysfunction, occurring in 11% of critically ill patients, presents a specific and independent risk factor for poor prognosis.
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Critical care medicine · Apr 2007
Patient safety event reporting in critical care: a study of three intensive care units.
To increase patient safety event reporting in three intensive care units (ICUs) using a new voluntary card-based event reporting system and to compare and evaluate observed differences in reporting among healthcare workers across ICUs. ⋯ This card-based reporting system increased reporting significantly compared with pre-intervention Web-based reporting and revealed significant differences in reporting by healthcare worker and ICU. These differences may reveal important preferences and priorities for reporting medical errors and patient safety events.
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Critical care medicine · Apr 2007
Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality.
The purpose of this study was to examine the outcome implications of implementing a severe sepsis bundle in an emergency department as a quality indicator set with feedback to modify physician behavior related to the early management of severe sepsis and septic shock. ⋯ Implementation of a severe sepsis bundle using a quality improvement feedback to modify physician behavior in the emergency department setting was feasible and was associated with decreased in-hospital mortality.