Critical care medicine
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Critical care medicine · Jul 2012
Multicenter StudyNutritional practices and their relationship to clinical outcomes in critically ill children--an international multicenter cohort study*.
To examine factors influencing the adequacy of energy and protein intake in the pediatric intensive care unit and to describe their relationship to clinical outcomes in mechanically ventilated children. ⋯ Nutrition delivery is generally inadequate in mechanically ventilated children across the world. Intake of a higher percentage of prescribed dietary energy goal via enteral route was associated with improved 60-day survival; conversely, parenteral nutrition use was associated with higher mortality. Pediatric intensive care units that utilized protocols for the initiation and advancement of enteral nutrient intake had a lower prevalence of acquired infections. Optimizing nutrition therapy is a potential avenue for improving clinical outcomes in critically ill children.
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Critical care medicine · Jul 2012
Multicenter StudyThe impact of early monitored management on survival in hospitalized adult Ugandan patients with severe sepsis: a prospective intervention study*.
In sub-Saharan Africa, sepsis is an important cause of mortality. Optimal sepsis management including fluid resuscitation, early antibiotic administration, and patient monitoring is limited by lack of supplies and skilled health workers. ⋯ Early, monitored management of severely septic patients in Uganda improves survival and is feasible and safe even in a busy public referral hospital.
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Critical care medicine · Jul 2012
Derivation of a cardiac arrest prediction model using ward vital signs*.
Rapid response team activation criteria were created using expert opinion and have demonstrated variable accuracy in previous studies. We developed a cardiac arrest risk triage score to predict cardiac arrest and compared it to the Modified Early Warning Score, a commonly cited rapid response team activation criterion. ⋯ The cardiac arrest risk triage score is simpler and more accurately detected cardiac arrest and intensive care unit transfer than the Modified Early Warning Score. Implementation of this tool may decrease rapid response team resource utilization and provide a better opportunity to improve patient outcomes than the modified early warning score.
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Critical care medicine · Jul 2012
The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: the VISIONS cohort magnetic resonance imaging study*.
Delirium duration is predictive of long-term cognitive impairment in intensive care unit survivors. Hypothesizing that a neuroanatomical basis may exist for the relationship between delirium and long-term cognitive impairment, we conducted this exploratory investigation of the associations between delirium duration, brain volumes, and long-term cognitive impairment. ⋯ These preliminary data show that longer duration of delirium is associated with smaller brain volumes up to 3 months after discharge, and that smaller brain volumes are associated with long-term cognitive impairment up to 12 months. We cannot, however, rule out that smaller preexisting brain volumes explain these findings.
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Critical care medicine · Jul 2012
Alveolar fluid in acute respiratory distress syndrome promotes fibroblast migration: role of platelet-derived growth factor pathway*.
Fibroblast migration is an initiating step in fibroproliferation; its involvement during acute lung injury and acute respiratory distress syndrome remains poorly understood. The aims of this study were: 1) to determine whether bronchoalveolar lavage fluids from patients with acute lung injury/acute respiratory distress syndrome modulate lung fibroblast migration; 2) to assess lung fibroblast migration's clinical relevance; and 3) to evaluate the role of the platelet-derived growth factor pathway in this effect. ⋯ : Together, our results suggest that during acute lung injury, fibroblast migration is modulated by bronchoalveolar lavage fluids through a platelet-derived growth factor/platelet-derived growth factor-sRα balance. Migration is associated with clinical severity and patient 28-day mortality.