Critical care medicine
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Critical care medicine · Sep 2009
Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study.
: To examine the effect of severity of acute kidney injury or renal recovery on risk-adjusted mortality across different intensive care unit settings. Acute kidney injury in intensive care unit patients is associated with significant mortality. ⋯ : Admission diagnosis and severity of illness influence frequency and severity of acute kidney injury. Small elevations in creatinine in the intensive care unit are associated with increased risk-adjusted mortality across all intensive care unit settings, whereas renal recovery was associated with a protective effect. Strategies to prevent even mild acute kidney injury or promote renal recovery may improve survival.
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Critical care medicine · Sep 2009
Randomized Controlled TrialPredicting the risk of documented ventilator-associated pneumonia for benchmarking: construction and validation of a score.
: To build and validate a ventilator-associated pneumonia risk score for benchmarking. The rate of ventilator-associated pneumonia varies widely with case-mix, a fact that has limited its use for measuring intensive care unit performance. ⋯ : The ventilator-associated pneumonia rate may be useful for benchmarking provided the ratio of observed over theoretical rates is used. External validation of our prediction score is needed.
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Critical care medicine · Sep 2009
Clostridium difficile-associated disease and mortality among the elderly critically ill.
: To describe the epidemiology of and to develop a simple 30-day mortality clinical decision rule among critically ill patients > or =65 yrs. Increasing incidence of hospitalizations with and emergence of hypervirulent epidemic strains have made Clostridium difficile-associated disease an important public health concern. Advanced age is a risk factor for development of and death from Clostridium difficile-associated disease. Intensive care unit patients with Clostridium difficile-associated disease have a high mortality, but neither the burden of nor risk factors for death among the elderly intensive care unit patients with Clostridium difficile-associated disease are well understood. ⋯ : Elderly patients represent approximately 50% of intensive care unit patients with Clostridium difficile-associated disease and have a higher 30-day mortality than younger patients. A simple prediction rule incorporating determinants of 30-day mortality easily available at the bedside may aid in optimizing treatment decisions in this growing population.
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Critical care medicine · Sep 2009
Burden of early-onset candidemia: analysis of culture-positive bloodstream infections from a large U.S. database.
: To characterize the epidemiology and burden of early-onset, nonnosocomial candidemia. ⋯ : Early-onset candidemia seems to be a distinct entity, which is increasing in frequency and is associated with increased mortality risk, longer hospital stay, and higher hospital costs relative to bacterial bloodstream infection.
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Critical care medicine · Sep 2009
Assessing fluid responsiveness in critically ill patients: False-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle.
To determine whether peak systolic velocity of tricuspid annular motion assessed by tissue Doppler echocardiography (Sta), a right ventricular function parameter, can discriminate patients with true- and false-positive pulse pressure variation. Pulse pressure variation is used to predict fluid responsiveness in mechanically ventilated patients. However, this parameter has been reported to be falsely positive, especially in patients with right ventricular dysfunction. ⋯ A Sta value of <0.15 m/s seems to be an accurate parameter to detect false-positive pulse pressure variation. Echocardiography should therefore be performed before fluid infusion in patients with pulse pressure variation of >12%.