Critical care medicine
-
Critical care medicine · Jul 2014
Multicenter Study Comparative StudyA Comparison of Severe Hemodynamic Disturbances Between Dexmedetomidine and Propofol for Sedation in Neurocritical Care Patients.
Dexmedetomidine and propofol are commonly used sedatives in neurocritical care as they allow for frequent neurologic examinations. However, both agents are associated with significant hemodynamic side effects. The primary objective of this study is to compare the prevalence of severe hemodynamic effects in neurocritical care patients receiving dexmedetomidine and propofol. ⋯ Severe hypotension and bradycardia occur at similar prevalence in neurocritical care patients who receive dexmedetomidine or propofol. Providers should similarly consider the likelihood of hypotension or bradycardia before starting either sedative.
-
Critical care medicine · Jul 2014
Multicenter StudySedation, Sleep Promotion, and Delirium Screening Practices in the Care of Mechanically Ventilated Children: A Wake-Up Call for the Pediatric Critical Care Community.
To examine pediatric intensivist sedation management, sleep promotion, and delirium screening practices for intubated and mechanically ventilated children. ⋯ The results highlight the heterogeneity in sedation practices among intensivists who care for critically ill children as well as a paucity of sleep promotion and delirium screening in PICUs worldwide.
-
Critical care medicine · Jul 2014
Multicenter StudyImproved Prognosis of Septic Shock in Patients With Cirrhosis: A Multicenter Study.
To determine the evolution of the outcome of patients with cirrhosis and septic shock. ⋯ The outcome of patients with cirrhosis and septic shock has markedly improved over time, akin to the noncirrhotic population. In 2010, the in-ICU survival rate was 35%, which now fully justifies to admit these patients to ICU.
-
Critical care medicine · Jul 2014
Multicenter StudyCharacteristics and Outcomes for Hospitalized Patients With Recurrent Clinical Deterioration and Repeat Medical Emergency Team Activation.
To describe the occurrence of recurrent clinical deterioration and repeat medical emergency team activation and assess its effect on processes and outcomes of care. ⋯ Recurrent clinical deterioration and repeat medical emergency team activation are common and associated with increased risk of subsequent ICU admission, increased length of hospital stay, and increased hospital mortality. It may be possible to identify patients at risk of recurrent clinical deterioration following medical emergency team activation and target interventions to improve patient care.
-
Critical care medicine · Jul 2014
Multicenter StudyAssociation Between the Choice of IV Crystalloid and In-Hospital Mortality Among Critically Ill Adults With Sepsis.
Isotonic saline is the most commonly used crystalloid in the ICU, but recent evidence suggests that balanced fluids like Lactated Ringer's solution may be preferable. We examined the association between choice of crystalloids and in-hospital mortality during the resuscitation of critically ill adults with sepsis. ⋯ Among critically ill adults with sepsis, resuscitation with balanced fluids was associated with a lower risk of in-hospital mortality. If confirmed in randomized trials, this finding could have significant public health implications, as crystalloid resuscitation is nearly universal in sepsis.