Critical care medicine
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Critical care medicine · Sep 2016
Routine Chest Radiography Is Not Necessary After Ultrasound-Guided Right Internal Jugular Vein Catheterization.
Central venous catheter placement is a common procedure performed on critically ill patients. Routine postprocedure chest radiographs are considered standard practice. We hypothesize that the rate of clinically relevant complications detected on chest radiographs following ultrasound-guided right internal jugular vein catheterization is exceedingly low. ⋯ In a large teaching hospital system, the overall rate of clinically relevant complications detected on chest radiographs following ultrasound-guided right internal jugular vein catheterization is exceedingly low. Routine chest radiograph after this common procedure is an unnecessary use of resources and may delay resuscitation of critically ill patients.
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Critical care medicine · Sep 2016
Incidence and Etiology of Potentially Preventable ICU Readmissions.
The rate of unplanned ICU readmissions is often considered a measure of hospital performance. However, the degree to which these readmissions are preventable and the causes of preventable readmissions are unknown, creating uncertainty about the feasibility and value of reducing ICU readmission rates. To inform this issue, we sought to determine the frequency and underlying causes of potentially preventable ICU readmissions. ⋯ The majority of early ICU readmissions are nonpreventable, raising important concerns about ICU readmission rates as a measure of hospital performance.
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Critical care medicine · Sep 2016
Inhibition of Intestinal Thiamin Transport in Rat Model of Sepsis.
Thiamin deficiency is highly prevalent in patients with sepsis, but the mechanism by which sepsis induces thiamin deficiency is unknown. This study aimed to determine the influence of various severity of sepsis on carrier-mediated intestinal thiamin uptake, level of expressions of thiamin transporters (thiamin transporter-1 and thiamin transporter-2), and mitochondrial thiamin pyrophosphate transporter. ⋯ For the first time, we demonstrated that sepsis inhibited carrier-mediated intestinal thiamin uptake as a function of sepsis severity, suppressed thiamin transporters and mitochondrial thiamin pyrophosphate transporter, leading to adenosine triphosphate depletion.
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Critical care medicine · Sep 2016
From Pediatrics to Geriatrics: Toward a Unified Standardized Screening Tool for Delirium: A Thought Experiment.
We aim to provide evidence for our view that a single, standardized (and preferably observational) screening tool for delirium should be used in patients of all ages (children, adults, and the elderly). ⋯ The proposed screening tools (Cornell Assessment of Pediatric Delirium and Delirium Observation Screening) entail all main diagnostic criteria, and so they are conceptually valid translations of delirium into operational terms. Given the much greater overlap than difference in this neuropsychiatric context of critical illness between children on the one hand and adults and elderly on the other, we propose that these tools would be ideal as the unified standardized screening tool.