Critical care medicine
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Critical care medicine · Nov 2015
Disappointing Success of Electrical Cardioversion for New-Onset Atrial Fibrillation in Cardiosurgical ICU Patients.
To assess the success of electrical cardioversion for the treatment of new-onset atrial fibrillation in critically ill patients and to evaluate the stability of sinus rhythm in responders during the subsequent 24 hours. ⋯ Biphasic electrical cardioversion in cardiosurgical ICU patients was immediately successful in restoring sinus rhythm in 71% of sessions. However, early relapse of atrial fibrillation was common in the 24-hour follow-up. At ICU discharge, the majority of patients were in sinus rhythm, but the efficacy of repetitive electrical cardioversion in restoring sinus rhythm was disappointing.
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Critical care medicine · Nov 2015
Comparative Study Observational StudyPredicting the Occurrence of Hypotension in Stable Patients With Nonvariceal Upper Gastrointestinal Bleeding: Point-of-Care Lactate Testing.
It is difficult to assess risk in normotensive patients with upper gastrointestinal bleeding. The aim of this study was to evaluate whether the initial lactate value can predict the in-hospital occurrence of hypotension in stable patients with acute nonvariceal upper gastrointestinal bleeding. ⋯ Point-of-care testing of lactate can predict in-hospital occurrence of hypotension in stable patients with acute nonvariceal upper gastrointestinal bleeding. However, subsequently, prospective validate research will be required to clarify this.
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Critical care medicine · Nov 2015
Higher Dead Space Is Associated With Increased Mortality in Critically Ill Children.
Elevated dead space has been consistently associated with increased mortality in adults with respiratory failure. In children, the evidence for this association is more limited. We sought to investigate the association between dead space and mortality in mechanically ventilated children. ⋯ Increased dead space is associated with higher mortality in critically ill children, although it is no longer independently associated with mortality after controlling for severity of oxygenation defect, inotrope use, and severity of illness. However, because end-tidal alveolar dead space fraction is easy to calculate at the bedside, it may be useful for risk stratification and severity-of-illness scores.
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Critical care medicine · Nov 2015
Comparative Study Observational StudyRaised Proinflammatory Cytokine Production Within Cerebrospinal Fluid Precedes Fever Onset in Patients With Neurosurgery-Associated Bacterial Meningitis.
The objective of the present study was to determine whether selective inflammatory cytokine concentrations within cerebrospinal fluid are useful markers for the differential diagnosis of aseptic and bacterial meningitis within neurosurgical patients. ⋯ The present study suggests that raised cerebrospinal fluid tumor necrosis factor -α, interleukin-1β, and interleukin-8 in a temporal manner may indicate early bacterial meningitis development in neurosurgical patients, enabling earlier diagnostic certainty and improved patient outcomes.