Critical care medicine
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Critical care medicine · Feb 2016
Multicenter Study Comparative StudyHow to Solve the Underestimated Problem of Overestimated Sodium Results in the Hypoproteinemic Patient.
The availability of a fast and reliable sodium result is a prerequisite for the appropriate correction of a patient's fluid balance. Blood gas analyzers and core laboratory chemistry analyzers measure electrolytes via different ion-selective electrode methodology, that is, direct and indirect ion-selective electrodes, respectively. Sodium concentrations obtained via both methods are not always concordant. A comparison of results between both methods was performed, and the impact of the total protein concentration on the sodium concentration was investigated. Furthermore, we sought to develop an adjustment equation to correct between both ion-selective electrode methods. ⋯ As Na⁺(direct) measurements on a blood gas analyzer are not influenced by the total protein concentration in the sample, they should be preferentially used in patients with abnormal protein concentrations. However, as blood gas analyzers are not available at all clinical wards, the implementation of a protein-corrected sodium result might provide an acceptable alternative.
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Critical care medicine · Feb 2016
Multicenter Study Observational StudyMulticenter Comparison of Machine Learning Methods and Conventional Regression for Predicting Clinical Deterioration on the Wards.
Machine learning methods are flexible prediction algorithms that may be more accurate than conventional regression. We compared the accuracy of different techniques for detecting clinical deterioration on the wards in a large, multicenter database. ⋯ In this multicenter study, we found that several machine learning methods more accurately predicted clinical deterioration than logistic regression. Use of detection algorithms derived from these techniques may result in improved identification of critically ill patients on the wards.
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Critical care medicine · Feb 2016
Clinical TrialRecruitment Maneuvers and Positive End-Expiratory Pressure Titration in Morbidly Obese ICU Patients.
The approach to applying positive end-expiratory pressure in morbidly obese patients is not well defined. These patients frequently require prolonged mechanical ventilation, increasing the risk for failed liberation from ventilatory support. We hypothesized that lung recruitment maneuvers and titration of positive end-expiratory pressure were both necessary to improve lung volumes and the elastic properties of the lungs, leading to improved gas exchange. ⋯ Commonly used positive end-expiratory pressure by clinicians is inadequate for optimal mechanical ventilation of morbidly obese patients. A recruitment maneuver followed by end-expiratory pressure titration was found to significantly improve lung volumes, respiratory system elastance, and oxygenation.
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This special article will review the history of blood glucose meter hospital use and current issues surrounding their use in this patient population. ⋯ Physicians who care for critically ill patients need to be cognizant of the accuracy and interference limitations of blood glucose meters and aware of the current regulatory situation.
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Critical care medicine · Feb 2016
Multicenter StudyA Severe Sepsis Mortality Prediction Model and Score for Use With Administrative Data.
Administrative data are used for research, quality improvement, and health policy in severe sepsis. However, there is not a sepsis-specific tool applicable to administrative data with which to adjust for illness severity. Our objective was to develop, internally validate, and externally validate a severe sepsis mortality prediction model and associated mortality prediction score. ⋯ Our sepsis severity model and score is a tool that provides reliable risk adjustment for administrative data.