Critical care medicine
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Critical care medicine · Jan 2011
Multicenter StudyMulticenter cohort study of out-of-hospital pediatric cardiac arrest.
To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest. ⋯ Multiple factors were identified as associated with survival after out-of-hospital pediatric cardiac arrest with the return of circulation. Additional information available within a few hours after the return of circulation may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.
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Critical care medicine · Jan 2011
Randomized Controlled Trial Comparative StudyJejunal tube placement in critically ill patients: A prospective, randomized trial comparing the endoscopic technique with the electromagnetically visualized method.
Head-to-head comparison of the success rate of jejunal placement of a new electromagnetically visualized jejunal tube with that of the endoscopic technique in critically ill patients. ⋯ In a head-to-head comparison correct jejunal tube placement using the new electromagnetically visualized method was as fast, safe, and successful as the endoscopic method in a comparative intensive care unit patient population.
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Critical care medicine · Jan 2011
Comparative StudyCardiorespiratory instability before and after implementing an integrated monitoring system.
Cardiorespiratory instability may be undetected in monitored step-down unit patients. We explored whether using an integrated monitoring system that continuously amalgamates single noninvasive monitoring parameters (heart rate, respiratory rate, blood pressure, and peripheral oxygen saturation) into AN instability index value (INDEX) correlated with our single-parameter cardiorespiratory instability concern criteria, and whether nurse response to INDEX alert for patient attention was associated with instability reduction. ⋯ The integrated monitoring system INDEX correlated significantly with cardiorespiratory instability concern criteria, usually occurred before overt instability, and when coupled with a nursing alert was associated with decreased cardiorespiratory instability concern criteria in step-down unit patients.
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Critical care medicine · Jan 2011
Multicenter StudyAdverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia.
To investigate the association between adverse events recorded during critical care and mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. ⋯ Adverse events were common after out-of-hospital cardiac arrest. Sustained hyperglycemia and seizures treated with anticonvulsants were associated with increased mortality. Bleeding and infection were more common after invasive procedures, but these adverse events were not associated with increased mortality in our study.
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Critical care medicine · Jan 2011
High permeability dialysis membrane allows effective removal of myoglobin in acute kidney injury resulting from rhabdomyolysis.
The objective of this study was to test the ability of myoglobin removal of a novel, high-permeability polysulphone dialyzer in acute kidney injury as a result of rhabdomyolysis. ⋯ Extended dialysis with a high-flux, high-permeability membrane allowed effective elimination of myoglobin with a clearance of myoglobin that surpassed all previously reported dialysis techniques. This membrane may be advantageous in preventing acute kidney injury or avoiding complete loss of kidney function in patients with rhabdomyolysis. Further studies are needed to determine whether improving renal recovery or mortality in patients with acute kidney injury resulting from rhabdomyolysis is possible.