Critical care medicine
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Critical care medicine · Mar 2015
Randomized Controlled TrialRandomized, Placebo-Controlled Trial of Acetaminophen for the Reduction of Oxidative Injury in Severe Sepsis: The Acetaminophen for the Reduction of Oxidative injury in Severe Sepsis Trial.
This trial evaluated the efficacy of acetaminophen in reducing oxidative injury, as measured by plasma F2-isoprostanes, in adult patients with severe sepsis and detectable plasma cell-free hemoglobin. ⋯ In adults with severe sepsis and detectable plasma cell-free hemoglobin, treatment with acetaminophen within 24 hours of ICU admission may reduce oxidative injury and improve renal function. Additional study is needed to confirm these findings and determine the effect of acetaminophen on patient-centered outcomes.
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Reversible stress-induced cardiac dysfunction is frequently seen as a complication of a multitude of acute stress states, in particular neurologic injuries. This dysfunction may be difficult to distinguish between that caused by myocardial ischemia and may impact both the treatment strategies and prognosis of the underlying condition. Critical care practitioners should have an understanding of the epidemiology, pathophysiology, clinical characteristics, precipitating conditions, differential diagnosis, and proposed treatments for stress-induced cardiomyopathy. ⋯ Stress-induced cardiomyopathy may mimic myocardial infarction and is an important condition to recognize in patients with underlying stress states, particularly neurologic injuries.
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Critical care medicine · Mar 2015
Multicenter StudyThe Impact of Hospital and ICU Organizational Factors on Outcome in Critically Ill Patients: Results From the Extended Prevalence of Infection in Intensive Care Study.
To investigate the impact of various facets of ICU organization on outcome in a large cohort of ICU patients from different geographic regions. ⋯ In this international large cohort of ICU patients, hospital and ICU characteristics varied worldwide. A high nurse:patient ratio was independently associated with a lower risk of in-hospital death. These exploratory data need to be confirmed in large prospective studies that consider additional country-specific ICU practice variations.
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Critical care medicine · Mar 2015
Randomized Controlled TrialPatients' Perspectives of Enrollment in Research Without Consent: The Patients' Experiences in Emergency Research-Progesterone for the Treatment of Traumatic Brain Injury Study.
Research in acute illness often requires an exception from informed consent. Few studies have assessed the views of patients enrolled in exception from informed consent trials. This study was designed to assess the views of patients and their surrogates of exception from informed consent enrollment within the context of a randomized, placebo-controlled trial of an investigational agent for traumatic brain injury. ⋯ Acceptance of exception from informed consent in this placebo-controlled trial of an investigational agent was high and exceeded acceptance among community consultation participants. Exception from informed consent enrollment appears generally consistent with patients' preferences.
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Critical care medicine · Mar 2015
Randomized Controlled TrialA Video to Improve Patient and Surrogate Understanding of Cardiopulmonary Resuscitation Choices in the ICU: A Randomized Controlled Trial.
To determine if a video depicting cardiopulmonary resuscitation and resuscitation preference options would improve knowledge and decision making among patients and surrogates in the ICU. ⋯ A video depicting cardiopulmonary resuscitation and explaining resuscitation preference options was associated with improved knowledge of in-hospital cardiopulmonary resuscitation options and cardiopulmonary resuscitation terminology among patients and surrogate decision makers in the ICU, compared with receiving a pamphlet on cardiopulmonary resuscitation. Patients and surrogates found the video helpful in decision making and would recommend the video to others.