Critical care medicine
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Critical care medicine · May 2014
Randomized Controlled Trial Multicenter StudyInfection Hospitalization Increases Risk of Dementia in the Elderly.
Severe infections, often requiring ICU admission, have been associated with persistent cognitive dysfunction. Less severe infections are more common and whether they are associated with an increased risk of dementia is unclear. We determined the association of pneumonia hospitalization with risk of dementia in well-functioning older adults. ⋯ Hospitalization with pneumonia is associated with increased risk of dementia.
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Critical care medicine · May 2014
Multicenter Study Observational StudyA Multinational Study of Thromboprophylaxis Practice in Critically Ill Children.
Although critically ill children are at increased risk for developing deep venous thrombosis, there are few pediatric studies establishing the prevalence of thrombosis or the efficacy of thromboprophylaxis. We tested the hypothesis that thromboprophylaxis is infrequently used in critically ill children even for those in whom it is indicated. ⋯ Thromboprophylaxis is infrequently used in critically ill children. This is true even for children at high risk of thrombosis where consensus guidelines recommend pharmacologic thromboprophylaxis.
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Critical care medicine · May 2014
Multicenter StudyImpact of Critical Care Nursing on 30-Day Mortality of Mechanically Ventilated Older Adults.
The mortality rate for mechanically ventilated older adults in ICUs is high. A robust research literature shows a significant association between nurse staffing, nurses' education, and the quality of nurse work environments and mortality following common surgical procedures. A distinguishing feature of ICUs is greater investment in nursing care. The objective of this study is to determine the extent to which variation in ICU nursing characteristics-staffing, work environment, education, and experience-is associated with mortality, thus potentially illuminating strategies for improving patient outcomes. ⋯ Patients in hospitals with better critical care nurse work environments and higher proportions of critical care nurses with a bachelor's degree in nursing experienced significantly lower odds of death.
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Critical care medicine · May 2014
Multicenter Study Comparative StudyOutcomes and Complications of Intracranial Pressure Monitoring in Acute Liver Failure: A Retrospective Cohort Study.
To determine if intracranial pressure monitor placement in patients with acute liver failure is associated with significant clinical outcomes. ⋯ In intracranial pressure monitored patients with acute liver failure, intracranial hypertension is commonly observed. The use of intracranial pressure monitor in acetaminophen acute liver failure did not confer a significant 21-day mortality benefit, whereas in nonacetaminophen acute liver failure, it may be associated with worse outcomes. Hemorrhagic complications from intracranial pressure monitor placement were uncommon and cannot account for mortality trends. Although our results cannot conclusively confirm or refute the utility of intracranial pressure monitoring in patients with acute liver failure, patient selection and ancillary assessments of cerebral blood flow likely have a significant role. Prospective studies would be required to conclusively account for confounding by illness severity and transplant.
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Critical care medicine · May 2014
Multicenter Study Observational StudySex- and Diagnosis-Dependent Differences in Mortality and Admission Cytokine Levels Among Patients Admitted for Intensive Care.
To investigate the role of sex on cytokine expression and mortality in critically ill patients. ⋯ The relationship between sex and outcomes in critically ill patients is complex and depends on underlying illness. Women appear to be better adapted to survive traumatic events, while sex may be less important in other forms of critical illness. The mechanisms accounting for this gender dimorphism may, in part, involve differential cytokine responses to injury, with men expressing a more robust proinflammatory profile.