Critical care medicine
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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.
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Critical care medicine · Apr 2007
Pericontusional brain tissue exhibits persistent elevation of lactate/pyruvate ratio independent of cerebral perfusion pressure.
To determine whether pericontusional tissue exhibits neurochemical responsiveness to changes in cerebral perfusion pressure as measured by microdialysis lactate/pyruvate ratio. ⋯ Sustained increases in lactate/pyruvate ratio occurred more frequently in pericontusional tissue compared with normal brain tissue. The lactate/pyruvate ratio was not related to cerebral perfusion pressure, nor was the percent time-burden of elevated lactate/pyruvate ratio related to any particular sustained cerebral perfusion pressure threshold. Lactate/pyruvate ratio values appear to be elevated despite cerebral perfusion pressure values customarily considered to be adequate.
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Critical care medicine · Apr 2007
Relationship between sublingual and intestinal microcirculatory perfusion in patients with abdominal sepsis.
To evaluate the relation between sublingual and intestinal microcirculatory alterations in patients with abdominal sepsis. ⋯ On day 1 of abdominal sepsis there is a complete dispersion of flow, not only between hemodynamic compartments of a different order but also between the sublingual and intestinal microcirculation. Over time, both sublingual and intestinal microvascular flow indexes trended to normal values.
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Critical care medicine · Apr 2007
Prioritizing the organization and management of intensive care services in the United States: the PrOMIS Conference.
Adult critical care services are a large, expensive part of U.S. health care. The current agenda for response to workforce shortages and rising costs has largely been determined by members of the critical care profession without input from other stakeholders. We sought to elicit the perceived problems and solutions to the delivery of critical care services from a broad set of U.S. stakeholders. ⋯ This consensus conference confirms that agreement on solutions to complex healthcare delivery problems can be achieved and that problem and solution frames expand with broader stakeholder participation. This process can be used as a model by other specialties to address priority setting in an era of shifting demographics and increasing resource constraints.
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Critical care medicine · Apr 2007
Early modifiable factors associated with fatal outcome in patients with severe traumatic brain injury: a case control study.
Survival of patients with severe traumatic brain injury may be improved by minimizing secondary brain injury. We aimed to identify potentially modifiable contributors to secondary brain injury that may persist and adversely affect patient outcome. ⋯ In patients with severe traumatic brain injury, lower blood pressure in the first 4 hrs after admission was associated with mortality and may have increased the rate of secondary brain injury. Outcomes of patients with severe traumatic brain injury may potentially be improved by early targeting of the higher mean arterial pressure observed in survivors (mean arterial pressure 80 mm Hg), which may facilitate improved cerebral perfusion. Slower initiation of intracranial pressure monitoring and of intensive care unit admission may also have adversely affected outcomes, whereas persistent hypothermia was associated with nonsurvival.