Critical care medicine
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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.
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Critical care medicine · Aug 2011
Comparative StudyImpact of previous antibiotic therapy on outcome of Gram-negative severe sepsis.
To determine whether exposure to antimicrobial agents in the previous 90 days resulted in decreased bacterial susceptibility and increased hospital mortality in patients with severe sepsis or septic shock attributed to Gram-negative bacteremia. ⋯ Recent antibiotic exposure is associated with increased hospital mortality in Gram-negative bacteremia complicated by severe sepsis or septic shock. Clinicians caring for patients with severe sepsis or septic shock should consider recent antibiotic exposure when formulating empiric antimicrobial regimens for suspected Gram-negative bacterial infection.
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Critical care medicine · Aug 2011
Multicenter Study Comparative StudyConstructing the illness narrative: a grounded theory exploring patients' and relatives' use of intensive care diaries.
After a stay in the intensive care unit, patients risk experiencing delusional memories, memory loss, and symptoms of posttraumatic stress. Since the 1990s, diaries have been kept for intensive care unit patients to help fill in memory gaps, aid psychosocial recovery, and improve health-related quality of life. More insight is needed into the application of diaries. The aim of our study was to explore how patients and relatives use diaries in the context of the illness trajectory. ⋯ Intensive care diaries are useful to patients as well as their relatives. Patients need to construct their illness narrative, and diaries are among the sources they use. The patients' project was to combine various sources of information in a process of information acquisition, narration, and evolving insight progressing toward recovery. The relatives supported the patients' project and also supported themselves by using the diary to uphold their own healing process. We recommend intensive care diaries as a low-technology, low-cost rehabilitative intervention for patients and relatives to help bridge the span from intensive care to recovery.
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Critical care medicine · Aug 2011
Incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit.
To determine the incidence and risk factors for health care-associated pneumonia in a pediatric intensive care unit. ⋯ Identification of independent predictors of health care-associated pneumonia may inform preventive measures. Strategies to optimize use of sedatives/analgesics, reduce the use of gastric tubes, and reduce the time on ventilation should be considered for inclusion in future intervention studies.
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Critical care medicine · Aug 2011
Comparative StudyThe intraoperative decrease of selenium is associated with the postoperative development of multiorgan dysfunction in cardiac surgical patients.
The trace elements selenium, copper, and zinc are essential for maintaining the oxidative balance. A depletion of antioxidative trace elements has been observed in critically ill patients and is associated with the development of multiorgan dysfunction and an increased mortality. Cardiac surgery using cardiopulmonary bypass provokes ischemia-reperfusion-mediated oxidative stress. We hypothesized that an intraoperative decrease of circulating trace elements may be involved in this response. ⋯ Cardiac surgery using cardiopulmonary bypass resulted in a profound intraoperative decrease of whole blood levels of antioxidant trace elements. Low selenium concentrations at end of surgery were an independent predictor for the postoperative development of multiorgan failure.