Critical care medicine
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Critical care medicine · Oct 2020
Letter Randomized Controlled TrialAntioxidative Amino Acids in Early Enteral Versus Parenteral Nutrition Following Major Rectal Surgery.
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Critical care medicine · Oct 2020
Mediators of the Impact of Hourly Net Ultrafiltration Rate on Mortality in Critically Ill Patients Receiving Continuous Renal Replacement Therapy.
During continuous renal replacement therapy, a high net ultrafiltration rate has been associated with increased mortality. However, it is unknown what might mediate its putative effect on mortality. In this study, we investigated whether the relationship between early (first 48 hr) net ultrafiltration and mortality is mediated by fluid balance, hemodynamic instability, or low potassium or phosphate blood levels using mediation analysis and the primary outcome was hospital mortality. ⋯ An early net ultrafiltration greater than 1.75 mL/kg/hr was independently associated with increased hospital mortality. Its putative effect on mortality was direct and not mediated by a causal pathway that included fluid balance, low blood pressure, vasopressor use, hypokalemia, or hypophosphatemia.
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Critical care medicine · Oct 2020
A Time-Phased Machine Learning Model for Real-Time Prediction of Sepsis in Critical Care.
As a life-threatening condition, sepsis is one of the major public health issues worldwide. Early prediction can improve sepsis outcomes with appropriate interventions. With the PhysioNet/Computing in Cardiology Challenge 2019, we aimed to develop and validate a machine learning algorithm with high prediction performance and clinical interpretability for prediction of sepsis onset during critical care in real-time. ⋯ The proposed Time-phAsed machine learning model for Sepsis Prediction model is accurate and interpretable for real-time prediction of sepsis onset in critical care, which holds great potential for further evaluation in prospective studies.
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Critical care medicine · Oct 2020
Multicenter StudyEvaluation of Vasopressor Exposure and Mortality in Patients With Septic Shock.
The objectives of this study were to: 1) determine the association between vasopressor dosing intensity during the first 6 hours and first 24 hours after the onset of septic shock and 30-day in-hospital mortality; 2) determine whether the effect of vasopressor dosing intensity varies by fluid resuscitation volume; and 3) determine whether the effect of vasopressor dosing intensity varies by dosing titration pattern. ⋯ Increasing vasopressor dosing intensity during the first 24 hours after septic shock was associated with increased mortality. This association varied with the amount of early fluid administration and the timing of vasopressor titration.
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Critical care medicine · Oct 2020
Multicenter Study Observational StudyImpact of Failure of Noninvasive Ventilation on the Safety of Pediatric Tracheal Intubation.
Noninvasive ventilation is widely used to avoid tracheal intubation in critically ill children. The objective of this study was to assess whether noninvasive ventilation failure was associated with severe tracheal intubation-associated events and severe oxygen desaturation during tracheal intubation. ⋯ Critically ill children are frequently exposed to noninvasive ventilation before intubation. Noninvasive ventilation failure was not independently associated with severe tracheal intubation-associated events or severe oxygen desaturation compared to primary tracheal intubation.