Critical care medicine
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Critical care medicine · Jul 2020
Multicenter StudyRisk of Mortality in Immunocompromised Children With Severe Sepsis and Septic Shock.
To assess the prevalence of immunocompromised diagnoses among children with severe sepsis and septic shock, and to determine the association between immunocompromised diagnoses and clinical outcomes after adjustment for demographics and illness severity. ⋯ Immunocompromised diagnoses are present in 28% of children with severe sepsis or septic shock. Multiple prior malignancies, hemophagocytic lymphohistiocytosis, congenital immunodeficiency, and hematopoietic cell transplant are independently associated with an increased odds of PICU mortality in children with severe sepsis or septic shock. Significant variation exists in PICU mortality among centers despite adjustment for immunocompromised diagnoses, known risk factors for sepsis-related mortality, and center-level sepsis volume.
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Critical care medicine · Jul 2020
Multicenter StudyUnplanned ICU Admission From Hospital Wards After Rapid Response Team Review in Australia and New Zealand.
To evaluate what proportion of unplanned ICU admissions from hospital wards occurred after rapid response team review and compare baseline characteristics and outcomes of patients admitted after rapid response team review with non-rapid response team-related admissions. ⋯ In Australia and New Zealand, hospital ward patients admitted to ICU following rapid response team review represent the majority of ward-based ICU admissions, are more chronically and acutely ill, and more frequently have sepsis than those admitted from the ward without rapid response team review. Their unadjusted outcomes are worse, but after adjustment their mortality is similar.
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Critical care medicine · Jul 2020
Multicenter StudyAdverse Events After Transition From ICU to Hospital Ward: A Multicenter Cohort Study.
To examine adverse events and associated factors and outcomes during transition from ICU to hospital ward (after ICU discharge). ⋯ Adverse events are common after ICU discharge to hospital ward and are associated with ICU readmission, increased hospital length of stay and death and are not predicted by ICU or ward physicians.
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Critical care medicine · Jul 2020
Multicenter StudyOpportunities to Improve Antibiotic Appropriateness in U.S. ICUs: A Multicenter Evaluation.
To use a standardized tool for a multicenter assessment of antibiotic appropriateness in ICUs and identify local antibiotic stewardship improvement opportunities. ⋯ In this multicenter point prevalence study, 31% of ICU antibiotic regimens were inappropriate; prophylactic regimens were often inappropriate across different ICU types, particularly in surgical ICUs. Engaging intensivists in antibiotic stewardship program efforts is crucial to sustain the efficacy of antibiotics and quality of infectious diseases care in critical care settings. This study underscores the value of standardized assessment tools and benchmarking to be shared with local leaders for targeted antibiotic stewardship program interventions.