Critical care medicine
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Critical care medicine · Oct 2018
The Impact of Early Adequate Treatment on Extubation and Discharge Alive of Patients With Pseudomonas aeruginosa-Related Ventilator-Associated Pneumonia.
We aim to examine the effect of early adequate treatment in comparison with inadequate or delayed treatment on being extubated or discharged alive over time, in patients with Pseudomonas aeruginosa-related ventilator-associated pneumonia. ⋯ Early adequate treatment does not seem to be associated with an improved prognosis. Its potential benefit requires further investigation in larger observational studies.
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Critical care medicine · Oct 2018
Meta AnalysisTranscranial Doppler in the Diagnosis of Cerebral Vasospasm: An Updated Meta-Analysis.
To evaluate the performance of transcranial Doppler and transcranial color-coded duplex Doppler in patients with cerebral vasospasm due to aneurysm rupture. Angiography was considered as the gold standard comparator. ⋯ Assuming a high prevalence of vasospasm of the middle cerebral artery, both transcranial Doppler and transcranial color-coded duplex Doppler are likely to detect it, but neither is useful to exclude it. There is no convincing evidence that the accuracy of transcranial color-coded duplex Doppler is any better than that of transcranial Doppler. For arteries other than middle cerebral artery, there is a lack of evidence of the usefulness of transcranial Doppler.
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Critical care medicine · Oct 2018
Hypertonic Lactate to Improve Cerebral Perfusion and Glucose Availability After Acute Brain Injury.
Lactate promotes cerebral blood flow and is an efficient substrate for the brain, particularly at times of glucose shortage. Hypertonic lactate is neuroprotective after experimental brain injury; however, human data are limited. ⋯ This is the first clinical demonstration that hypertonic lactate resuscitation improves both cerebral perfusion and brain glucose availability after brain injury. These cerebral vascular and metabolic effects appeared related to brain lactate supplementation rather than to systemic effects.
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Critical care medicine · Oct 2018
Multicenter StudyPregnancy-Related ICU Admissions From 2008 to 2016 in China: A First Multicenter Report.
To identify the key points for improving severe maternal morbidity by analyzing pregnancy-related ICU admissions in Beijing. ⋯ Our study highlights the increasing rate of intensive care admissions for postpartum hemorrhage. Improving prenatal care quality for pregnancy-induced hypertension and sepsis at lower-level hospitals may improve maternal and fetal outcomes. Specifically, providing more effective regional cooperation before transfer and shifting patients who require continuous surveillance but not necessarily intensive care to a transitional ward in a tertiary hospital would provide more ICU beds for more prenatal intensive care for the most complex medical conditions.
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Critical care medicine · Oct 2018
Patient Outcomes After the Introduction of Statewide ICU Nurse Staffing Regulations.
To assess whether Massachusetts legislation directed at ICU nurse staffing was associated with improvements in patient outcomes. ⋯ State regulation of patient-to-nurse staffing with the aid of patient complexity scores in intensive care was not associated with either increased nurse staffing or changes in patient outcomes.