Critical care medicine
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Critical care medicine · Jan 2012
Randomized Controlled TrialEconomic evaluation of chlorhexidine-impregnated sponges for preventing catheter-related infections in critically ill adults in the Dressing Study.
The randomized two-way factorial Dressing Study (1,636 patients, 28,931 catheter days) showed that a chlorhexidine-impregnated sponge decreased the incidence of major catheter-related infections from 1.4‰ to 0.6‰ catheter days, and that scheduled dressing changes every 7 days was not inferior to scheduled changes every 3 days. Here, we assessed the cost benefits of chlorhexidine-impregnated sponge use. ⋯ Chlorhexidine-impregnated sponge for arterial and central venous catheters saves money by preventing major catheter-related infections, even in intensive care units with low baseline major catheter-related infection levels.
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Critical care medicine · Jan 2012
Multicenter StudyThe role of the medical emergency team in end-of-life care: a multicenter, prospective, observational study.
To investigate the role of medical emergency teams in end-of-life care planning. ⋯ Issues around end-of-life care and limitations of medical therapy arose in approximately one-third of calls, suggesting a mismatch between patient needs for end-of-life care and resources at participating hospitals. These calls frequently occur in elderly medical patients and out of hours. Many such patients do not return home, and half die in hospital. There is a need for improved advanced care planning in our hospitals, and to confirm our findings in other organizations.
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Critical care medicine · Jan 2012
Multicenter StudyThe Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderly.
Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. ⋯ Despite the fact that elderly patients have more intensive care unit rejections than younger patients and have a higher mortality when admitted, the mortality benefit appears greater for the elderly. Physicians should consider changing their intensive care unit triage practices for the elderly.
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Critical care medicine · Jan 2012
External validation of a prognostic model predicting time of death after withdrawal of life support in neurocritical patients.
The ability to predict the time of death after withdrawal of life support is of specific interest for organ donation after cardiac death. We aimed to externally validate a previously developed model to predict the probability of death within the time constraint of 60 mins after withdrawal of life-sustaining measures. ⋯ The model discriminated well between patients who died within 60 mins after withdrawal of life support and those who did not. Further prospective validation is needed.
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Critical care medicine · Jan 2012
Multicenter StudyImpact of case volume on survival of septic shock in patients with malignancies.
Septic shock is a frequent and severe complication in the course of malignancies. In a large multicenter cohort of septic shock patients with hematologic malignancies and solid tumors, we assessed the temporal trend in survival and the prognostic factors, with particular emphasis on case volume. ⋯ Survival of septic shock patients with malignancies markedly increased over the recent years. Furthermore, we identified case volume as a major prognostic factor in this setting.