Critical care medicine
-
Critical care medicine · Sep 2014
Review Meta AnalysisLactate Clearance Is a Useful Biomarker for the Prediction of All-Cause Mortality in Critically Ill Patients: A Systematic Review and Meta-Analysis.
Lactate clearance has been widely investigated for its prognostic value in critically ill patients. However, the results are conflicting. The present study aimed to explore the diagnostic accuracy of lactate clearance in predicting mortality in critically or acutely ill patients. ⋯ Our study demonstrates that lactate clearance is predictive of lower mortality rate in critically ill patients, and its diagnostic performance is optimal for clinical utility.
-
Critical care medicine · Sep 2014
Randomized Controlled Trial Multicenter StudyA Multicenter, Randomized Clinical Trial of IV Iron Supplementation for Anemia of Traumatic Critical Illness.
To evaluate the efficacy of IV iron supplementation of anemic, critically ill trauma patients. ⋯ Iron supplementation increased the serum ferritin concentration significantly, but it had no discernible effect on transferrin saturation, iron-deficient erythropoiesis, hemoglobin concentration, or packed RBC transfusion requirement. Based on these data, routine IV iron supplementation of anemic, critically ill trauma patients cannot be recommended (NCT 01180894).
-
Critical care medicine · Sep 2014
Multicenter StudyRapid Response Team Implementation and In-Hospital Mortality.
To determine the relationship between implementation of rapid response teams and improved mortality rate using a large, uniform dataset from one state in the United States. ⋯ In-hospital mortality improved in six of 10 acute tertiary care hospitals in the post-rapid response team time period when compared with the pre-rapid response team time period. Because of a long-term trend of decline in hospital mortality, these decreases could not be unambiguously attributed to rapid response team implementation. Further research should examine additional objective outcomes and optimal configuration of rapid response teams to maximize intervention effectiveness.
-
When used to prolong life without achieving a benefit meaningful to the patient, critical care is often considered "futile." Although futile treatment is acknowledged as a misuse of resources by many, no study has evaluated its opportunity cost, that is, how it affects care for others. Our objective was to evaluate delays in care when futile treatment is provided. ⋯ Futile critical care was associated with delays in care to other patients.
-
Critical care medicine · Sep 2014
ReviewWhen Cardiac Failure, Kidney Dysfunction, and Kidney Injury Intersect in Acute Conditions: The Case of Cardiorenal Syndrome.
To review and describe diagnostic and prognostic value of biomarkers of renal function and renal injury in the cardiorenal syndrome complicating acutely decompensated heart failure. ⋯ Biomarkers reflecting renal function and injury are likely to better phenotype subgroups of patients with cardiorenal syndrome and to provide unique prognostic information. Future studies are needed relative to strategies using such biomarkers to guide care of affected patients.