Critical care medicine
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Critical care medicine · Jul 2015
Prehospital Hypotension Is Associated With Altered Inflammation Dynamics and Worse Outcomes Following Blunt Trauma in Humans.
To define the impact of prehospital hypotension on the dynamic, systemic acute inflammatory response to blunt trauma. ⋯ Studies in stringently matched patient cohorts suggest that an episode of prehospital hypotension post trauma leads to early, dynamic reprogramming of systemic inflammation (including differential upstream regulation of interleukin-6), which is associated with worse outcomes.
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Critical care medicine · Jul 2015
Temporal Changes in the Influence of Hospitals and Regional Healthcare Networks on Severe Sepsis Mortality.
There is systematic variation between hospitals in their care of severe sepsis, but little information on whether this variation impacts sepsis-related mortality, or how hospitals' and health-systems' impacts have changed over time. We examined whether hospital and regional organization of severe sepsis care is associated with meaningful differences in 30-day mortality in a large integrated health care system, and the extent to which those effects are stable over time. ⋯ In this large integrated healthcare system, there is clinically significant variation in sepsis-related mortality associated with hospitals and regions. The proportion of variance explained by hospitals and regions has been stable over time, although sepsis-related mortality has declined.
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Critical care medicine · Jul 2015
ReviewPostoperative Critical Care of the Adult Cardiac Surgical Patient. Part I: Routine Postoperative Care.
Cardiac surgery, including coronary artery bypass, cardiac valve, and aortic procedures, is among the most common surgical procedures performed in the United States. Successful outcomes after cardiac surgery depend on optimum postoperative critical care. The cardiac intensivist must have a comprehensive understanding of cardiopulmonary physiology and the sequelae of cardiopulmonary bypass. In this concise review, targeted at intensivists and surgeons, we discuss the routine management of the postoperative cardiac surgical patient. ⋯ Critical care of the cardiac surgical patient is a complex and dynamic endeavor. Adequate fluid resuscitation, appropriate inotropic support, attention to rewarming, and ventilator management are key components. Patient safety is enhanced by experienced personnel, a structured handover between the operating room and ICU teams, and appropriate transfusion strategies.
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Critical care medicine · Jul 2015
Observational StudyEffect of Early Intervention on Long-Term Outcomes of Critically Ill Cancer Patients Admitted to ICUs.
The objective of this observational study was to evaluate whether early intervention was associated with improved long-term outcomes in critically ill patients with cancer. ⋯ Early intervention for clinical derangement on general wards was significantly associated with long-term outcomes in critically ill cancer patients.