Critical care medicine
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Critical care medicine · Mar 2015
Randomized Controlled Trial Multicenter StudyInvasive Candida Infections and the Harm From Antibacterial Drugs in Critically Ill Patients: Data From a Randomized, Controlled Trial to Determine the Role of Ciprofloxacin, Piperacillin-Tazobactam, Meropenem, and Cefuroxime.
Use of antibiotics in critically ill patients may increase the risk of invasive Candida infection. The objective of this study was to determine whether increased exposure to antibiotics is associated with increased prevalence of invasive Candida infection. ⋯ High exposure to antibiotics is associated to increased risk of invasive Candida infection in medical intensive care patients. Patients with ciprofloxacin-containing regimens had higher risk of invasive Candida infection. Other antibiotics, such as meropenem, piperacillin/tazobactam, and cefuroxime, were not associated with such a risk.
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Critical care medicine · Mar 2015
Randomized Controlled Trial Multicenter StudyElevated Plasma Free Cortisol Concentrations and Ratios Are Associated With Increased Mortality Even in the Presence of Statin Therapy in Patients With Severe Sepsis.
Dissociation between plasma-free cortisol and total cortisol profiles exists in critical illness. Data on plasma-free cortisol are based on either calculated values or immunoassay-based measurements. Both have significant limitations. Statins have been advocated as a therapy in sepsis. Whether they impact on plasma cortisol through inhibition of cholesterol synthesis is unclear. ⋯ In severe sepsis, plasma-free cortisol increase is 10-fold greater than that of plasma total cortisol. Both are similarly associated with inflammatory response and mortality. Elevated plasma-free cortisol/plasma total cortisol ratios were associated with increased length of stay. Statin therapy does not influence the plasma cortisol profiles in patients with severe sepsis.
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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
Multicenter StudyCo-occurrence of and Remission From General Anxiety, Depression, and Posttraumatic Stress Disorder Symptoms After Acute Lung Injury: A 2-Year Longitudinal Study.
To evaluate the cooccurrence, and predictors of remission, of general anxiety, depression, and posttraumatic stress disorder symptoms during 2-year follow-up in survivors of acute lung injury treated in an ICU. ⋯ The majority of acute lung injury survivors had clinically significant general anxiety, depression, or posttraumatic stress disorder symptoms, and these symptoms tended to co-occur across domains. Better physical functioning during recovery predicted subsequent remission of general anxiety and posttraumatic stress disorder symptoms.
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Critical care medicine · Mar 2015
Multicenter StudyQuality of Communication in the ICU and Surrogate's Understanding of Prognosis*.
Although misperceptions about prognosis by surrogates in ICUs are common and influence treatment decisions, there is no validated, practical way to measure the effectiveness of prognostic communication. Surrogates' subjective ratings of quality of communication have been used in other domains as markers of effectiveness of communication. We sought to determine whether surrogates' subjective ratings of the quality of prognostic communication predict accurate expectation about prognosis by surrogates. ⋯ Although most surrogates rate the quality of prognostic communication high, inaccurate expectations about prognosis are common among surrogates. Surrogates' ratings of the quality of prognostic communication do not reliably predict an accurate expectation about prognosis.