Critical care medicine
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Critical care medicine · May 2012
Randomized Controlled Trial Multicenter StudyOccurrence and impact of intracranial pressure elevation during treatment of severe intraventricular hemorrhage.
Elevated intracranial pressure is one of the proposed mechanisms leading to poor outcomes in patients with intraventricular hemorrhage. We sought to characterize the occurrence and significance of intracranial hypertension in severe intraventricular hemorrhage requiring extraventricular drainage. ⋯ Intracranial pressure is not frequently elevated during monitoring and drainage with an extraventricular drainage in patients with severe intraventricular hemorrhage, although intracranial pressure >30 mm Hg predicts higher short-term mortality. Thrombolytic therapy may reduce the frequency of high intracranial pressure events. Intracranial pressure elevation appears to be significantly correlated with extraventricular drainage placement in the ventricle with greatest clot volume.
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Critical care medicine · May 2012
Multicenter StudyCritical illness from 2009 pandemic influenza A virus and bacterial coinfection in the United States.
The contribution of bacterial coinfection to critical illness associated with 2009 influenza A virus infection remains uncertain. The objective of this study was to determine whether bacterial coinfection increased the morbidity and mortality of 2009 influenza A. ⋯ Among intensive care unit patients with 2009 influenza A, bacterial coinfection diagnosed within 72 hrs of admission, especially with Staphylococcus aureus, was associated with significantly higher morbidity and mortality.
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Critical care medicine · May 2012
Multicenter StudyEvaluating the use of recombinant human activated protein C in adult severe sepsis: results of the Surviving Sepsis Campaign.
The Surviving Sepsis Campaign developed guidelines for the administration of recombinant human activated protein C in adult severe sepsis. However, it is not clear how these impacted clinical practice or patient outcome. ⋯ Recombinant human activated protein C use was associated with a significant improvement in hospital mortality in patients who participated in the Surviving Sepsis Campaign.
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Critical care medicine · May 2012
Multicenter StudyRelationship between neighborhood poverty rate and bloodstream infections in the critically ill.
Poverty is associated with increased risk of chronic illness, but its contribution to bloodstream infections is not well-defined. ⋯ Within the limitations of our study design, increased neighborhood poverty rate, a proxy for decreased socioeconomic status, appears to be associated with risk of bloodstream infection among patients who receive critical care.
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Critical care medicine · May 2012
Multicenter StudyVariability of antibiotic concentrations in critically ill patients receiving continuous renal replacement therapy: a multicentre pharmacokinetic study.
In critically ill patients receiving continuous renal replacement therapy, we aimed to assess the variability of antibiotic trough concentrations, the influence of effluent flow rates on such concentrations, and the incidence of suboptimal antibiotic dosage. ⋯ There is significant variability in antibiotic trough concentrations in critically ill patients receiving continuous renal replacement therapy, which did not only appear to be influenced by effluent flow rate. Here, empirical dosing of antibiotics failed to achieve the target trough antibiotic concentration during 25% of the dosing intervals.