Critical care medicine
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Critical care medicine · Sep 2015
Multicenter StudyFive-Year Survival of Children With Chronic Critical Illness in Australia and New Zealand.
Outcomes for children with chronic critical illness are not defined. We examined the long-term survival of these children in Australia and New Zealand. ⋯ Two thirds of children with chronic critical illness survive for at-least 5 years, but there was no improvement between 2000 and 2011. Cardiac disease constitutes an increasing proportion of pediatric chronic critical illness. Bone marrow transplant recipients and single-ventricle physiology have the poorest outcomes.
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Critical care medicine · Sep 2015
Cigarette Smoke Exposure and the Acute Respiratory Distress Syndrome.
The association between cigarette smoke exposure and the acute respiratory distress syndrome in patients with the most common acute respiratory distress syndrome risk factors of sepsis, pneumonia, and aspiration has not been well studied. The goal of this study was to test the association between biomarker-confirmed cigarette smoking and acute respiratory distress syndrome in a diverse cohort. ⋯ Cigarette smoking measured both by history and biomarker is associated with an increased risk of acute respiratory distress syndrome in patients with nonpulmonary sepsis. This finding has important implications for tobacco product regulation and for understanding the pathogenesis of acute respiratory distress syndrome.
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Critical care medicine · Sep 2015
Community-, Healthcare-, and Hospital-Acquired Severe Sepsis Hospitalizations in the University HealthSystem Consortium.
Severe sepsis poses a major burden on the U.S. healthcare system. Previous epidemiologic studies have not differentiated community-acquired severe sepsis from healthcare-associated severe sepsis or hospital-acquired severe sepsis hospitalizations. We sought to compare and contrast community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis hospitalizations in a national hospital sample. ⋯ In this series, severe sepsis hospitalizations included community-acquired severe sepsis (62.8%), healthcare-associated severe sepsis (25.9%), and hospital-acquired severe sepsis (11.3%) cases. Hospital-acquired severe sepsis was associated with both higher mortality and resource utilization than community-acquired severe sepsis and healthcare-associated severe sepsis.
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Critical care medicine · Sep 2015
Clinical TrialBrief Versus Full Alcohol Use Disorders Identification Test in National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network Clinical Trials.
Alcohol use disorders are common among patients admitted to an ICU, yet systematic screening is rarely performed. We sought to confirm the construct validity of the full Alcohol Use Disorders Identification Test and to evaluate the performance of the brief three-item Alcohol Use Disorders Identification Test-C using the full Alcohol Use Disorders Identification Test as a proxy gold standard in a population of patients with a medical critical illness. ⋯ Although a three-factor structure for the Alcohol Use Disorders Identification Test was confirmed in ICU patients with acute respiratory distress syndrome, the first three questions focusing on alcohol consumption provide information that is comparable with the full 10-item Alcohol Use Disorders Identification Test screening questionnaire. This study is limited by the lack of a true gold standard, and the performance of the Alcohol Use Disorders Identification Test -C is likely overestimated due to this limitation.
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Critical care medicine · Sep 2015
Clinical and Physiological Events That Contribute to the Success Rate of Finding "Optimal" Cerebral Perfusion Pressure in Severe Brain Trauma Patients.
Recently, a concept of an individually targeted level of cerebral perfusion pressure that aims to restore impaired cerebral vasoreactivity has been advocated after traumatic brain injury. The relationship between cerebral perfusion pressure and pressure reactivity index normally is supposed to have a U-shape with its minimum interpreted as the value of "optimal" cerebral perfusion pressure. The aim of this study is to investigate the relation between the absence of the optimal cerebral perfusion pressure curve and physiological variables, clinical factors, and interventions. ⋯ This study identified six factors that were independently associated with absence of optimal cerebral perfusion pressure curves.