Critical care medicine
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Critical care medicine · Aug 2011
Review Meta AnalysisSubglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis.
Aspiration of secretions containing bacterial pathogens into the lower respiratory tract is the main cause of ventilator-associated pneumonia. Endotracheal tubes with subglottic secretion drainage can potentially reduce this and, therefore, the incidence of ventilator-associated pneumonia. New evidence on subglottic secretion drainage as a preventive measure for ventilator-associated pneumonia has been recently published and to consider the evidence in totality, we conducted an updated systematic review and meta-analysis. ⋯ In those at risk for ventilator-associated pneumonia, the use of endotracheal tubes with subglottic secretion drainage is effective for the prevention of ventilator-associated pneumonia and may be associated with reduced duration of mechanical ventilation and intensive care unit length of stay.
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Critical care medicine · Aug 2011
Multicenter Study Comparative StudyOutcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality.
We evaluated the respective influence of the causative pathogen and infection site on hospital mortality from severe sepsis related to community-, hospital-, and intensive care unit-acquired infections. ⋯ The infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and, above all, appropriateness of early antimicrobials are taken into account. Our findings emphasize the importance of developing valid recommendations for early antimicrobial therapy.
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Critical care medicine · Aug 2011
Multicenter Study Comparative StudyRed cell distribution width and all-cause mortality in critically ill patients.
Red cell distribution width is a predictor of mortality in the general population. The prevalence of increased red cell distribution width and its significance in the intensive care unit are unknown. The objective of this study was to investigate the association between red cell distribution width at the initiation of critical care and all cause mortality. ⋯ Red cell distribution width is a robust predictor of the risk of all-cause patient mortality and bloodstream infection in the critically ill. Red cell distribution width is commonly measured, inexpensive, and widely available and may reflect overall inflammation, oxidative stress, or arterial underfilling in the critically ill.
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Critical care medicine · Aug 2011
Editorial Comment Comparative StudyPrediction is very difficult, especially about the future-Niels Bohr.
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Critical care medicine · Aug 2011
Multicenter Study Comparative StudyUnderstanding the potential role of statins in pneumonia and sepsis.
To examine the association of statin use with clinical outcomes and circulating biomarkers in community-acquired pneumonia and sepsis. ⋯ We found no evidence of a protective effect for statin use on clinical outcomes and only modest differences in circulating biomarkers in community-acquired pneumonia, perhaps as a result of healthy user effects and indication bias.