Critical care medicine
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Critical care medicine · Nov 2015
Comparative StudyThe Centers for Disease Control and Prevention's New Definitions for Complications of Mechanical Ventilation Shift the Focus of Quality Surveillance and Predict Clinical Outcomes in a PICU.
The Centers for Disease Control and Prevention shifted the focus of surveillance paradigm for adult patients receiving mechanical ventilation, moving from the current standard of ventilator-associated pneumonia to broader complications. The surveillance definitions were designed to enable objective measures and efficient processes, so as to facilitate quality improvement initiatives and enhance standardized benchmark comparisons. We evaluated the surveillance definitions in term of their ability to predict clinical outcomes and ease of surveillance in a PICU. ⋯ The definitions for the various ventilator-associated conditions are good predictors of outcomes in children and adults and are amenable to automated surveillance. Based on the study findings, we suggest consideration for shifting the focus of surveillance for ventilator-associated events from only pneumonia to a broader range of complications.
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Critical care medicine · Nov 2015
Multicenter StudyAcutely Bereaved Surrogates' Stories About the Decision to Limit Life Support in the ICU.
Participating in a decision to limit life support for a loved one in the ICU is associated with adverse mental health consequences for surrogate decision makers. We sought to describe acutely bereaved surrogates' experiences surrounding this decision. ⋯ In this all-white sample of surrogates with nonpassive decision control preferences from a single US region, participating in decision making allowed surrogates to regain control, counteract feelings of helplessness, and end their empathic suffering. Although previous research highlighted the distress caused by participation in a decision to limit life support, the act of decision making may, counterintuitively, help some surrogates cope with the experience.
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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 StudyImaging Lymphoid Cell Death In Vivo During Polymicrobial Sepsis.
Cell death in lymphatic organs, such as the spleen, is in part responsible for immunosuppression and contributes to mortality during sepsis. An early and noninvasive detection of lymphoid cell death could thus have significant clinical implications. Here, we tested in vivo imaging of lymphoid cell death using a near-infrared annexin V (AV-750). ⋯ In vivo AV-750 fluorescent imaging provides spatially resolved and organ-specific detection of lymphoid cell death during polymicrobial sepsis. The AV-750 fluorescent intensity in the thoracic and abdominal fields is associated with sepsis severity and well correlated with sepsis-induced cell death in the thymus and spleen, respectively.
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Critical care medicine · Nov 2015
Comparative StudyKinin B1 Receptor Antagonist BI113823 Reduces Acute Lung Injury.
This study was undertaken to examine the effects of BI113823, a potent small molecule orally active nonpeptide B1 receptor antagonist, in an experimental model of endotoxin-induced direct lung injury in mice and indirect lung injury and survival in cecal ligation and puncture-induced polymicrobial sepsis in rats. ⋯ Administration of B1 receptor antagonist BI113823 significantly reduced endotoxin-induced direct lung injury and also reduced sepsis-induced lung inflammatory response. Most importantly, BI113823 improved survival following severe polymicrobial sepsis.