Critical care medicine
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Critical care medicine · Oct 2011
Multicenter Study Comparative StudyDefinition of mortality for trauma center performance evaluation: a comparative study.
Mortality is widely used as a performance indicator to evaluate the quality of trauma care, but there is no consensus on the most appropriate definition. Our objective was to evaluate the influence of the definition of mortality in terms of the place (in-hospital or postdischarge) and time (30 days and 3, 6, and 12 months) of death on the results of trauma center performance evaluations according to the patients' ages. ⋯ We observed an important variation in performance evaluation results across definitions of mortality, specifically in patients aged≥65 yrs. Half of the deaths among elders occurred later than 30 days following admission, including a significant number postdischarge. Results suggest that if performance evaluations include elderly patients, data on postdischarge mortality up to 6 months following admission are required.
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Critical care medicine · Oct 2011
Multicenter StudyIntensive care unit discharge to the ward with a tracheostomy cannula as a risk factor for mortality: a prospective, multicenter propensity analysis.
To analyze the impact of decannulation before intensive care unit discharge on ward survival in nonexperimental conditions. ⋯ In our multicenter setting, intensive care unit discharge before decannulation is not a risk factor.
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Critical care medicine · Oct 2011
Multicenter StudyNoninvasive versus invasive ventilation for acute respiratory failure in patients with hematologic malignancies: a 5-year multicenter observational survey.
Mortality is high among patients with hematologic malignancies admitted to intensive care units for acute respiratory failure. Early noninvasive mechanical ventilation seems to improve outcomes. ⋯ In patients with hematologic malignancies, acute respiratory failure should probably be managed initially with noninvasive mechanical ventilation. Further study is needed to determine whether immediate invasive mechanical ventilation might offer some benefits for those with acute lung injury/adult respiratory distress syndrome.
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Critical care medicine · Oct 2011
Multicenter StudyHypoglycemia at admission is associated with inhospital mortality in Ugandan patients with severe sepsis.
Dysglycemia during sepsis is associated with poor outcomes in resource-rich settings. In resource-limited settings, hypoglycemia is often diagnosed clinically without the benefit of laboratory support. We studied the utility of point-of-care glucose monitoring to predict mortality in severely septic patients in Uganda. ⋯ Hypoglycemia is an independent risk factor for inhospital mortality in patients with severe sepsis and cannot be adequately assessed by clinical examination. Correction of hypoglycemia may improve outcomes of critically ill patients in resource-limited settings.
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Critical care medicine · Oct 2011
Multicenter StudyClinical practices, complications, and mortality in neurological patients with acute severe hypertension: the Studying the Treatment of Acute hyperTension registry.
To determine the demographic and clinical features, hospital complications, and predictors of 90-day mortality in neurologic patients with acute severe hypertension. ⋯ Neurologic emergencies account for approximately 30% of hospitalized patients with severe acute hypertension, and the majority of those who die. Mortality in hypertensive neurologic patients is associated with lower minimum blood pressure values, less rebound hypertension, and a higher frequency of neurologic deterioration. Excessive blood pressure reduction may contribute to poor outcome after severe brain injury.