Critical care medicine
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Critical care medicine · Sep 2020
Multicenter StudyRates of Venous Thromboembolism and Central Line-Associated Bloodstream Infections Among Types of Central Venous Access Devices in Critically Ill Children.
Central venous access devices, including peripherally inserted central catheters and central venous catheters, are often needed in critically ill patients, but also are associated with complications, including central-line associated bloodstream infections and venous thromboembolism. We compared different central venous access device types and these complications in the PICU. ⋯ Peripherally inserted central catheters are associated with higher rates of central-line associated bloodstream infection and venous thromboembolism than central venous catheters in children admitted to the PICU.
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Critical care medicine · Sep 2020
Inhibitory Immune Checkpoint Molecule Expression in Clinical Sepsis Studies: A Systematic Review.
Checkpoint inhibitors have been proposed for sepsis following reports of increased checkpoint molecule expression in septic patients. To determine whether clinical studies investigating checkpoint molecule expression provide strong evidence supporting trials of checkpoint inhibitors for sepsis. ⋯ Although sepsis may increase some checkpoint molecule expression compared with healthy controls, the data are limited and inconsistent. Further, data from the more informative patient comparisons are potentially confounded by severity of illness. These clinical checkpoint molecule expression studies do not yet provide a strong rationale for trials of checkpoint inhibitor therapy for sepsis.
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Critical care medicine · Sep 2020
Difficult Bag-Mask Ventilation in Critically Ill Children Is Independently Associated With Adverse Events.
Bag-mask ventilation is commonly used prior to tracheal intubation; however, the epidemiology, risk factors, and clinical implications of difficult bag-mask ventilation among critically ill children are not well studied. This study aims to describe prevalence and risk factors for pediatric difficult bag-mask ventilation as well as its association with adverse tracheal intubation-associated events and oxygen desaturation in PICU patients. ⋯ Difficult bag-mask ventilation is reported in approximately one in 10 PICU patients undergoing tracheal intubation. Given its association with adverse procedure-related events and oxygen desaturation, future study is warranted to improve preprocedural planning and real-time management strategies.
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Critical care medicine · Sep 2020
External Validation of an Acute Respiratory Distress Syndrome Prediction Model Using Radiology Reports.
Acute respiratory distress syndrome is frequently under recognized and associated with increased mortality. Previously, we developed a model that used machine learning and natural language processing of text from radiology reports to identify acute respiratory distress syndrome. The model showed improved performance in diagnosing acute respiratory distress syndrome when compared to a rule-based method. In this study, our objective was to externally validate the natural language processing model in patients from an independent hospital setting. ⋯ Our computable phenotype for acute respiratory distress syndrome had good discrimination in external validation and may be used by other health systems for case-identification. Discrepancies in feature representation are likely due to differences in characteristics of the patient cohorts.
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Critical care medicine · Sep 2020
Observational StudyICU and Ventilator Mortality Among Critically Ill Adults With Coronavirus Disease 2019.
To determine mortality rates among adults with critical illness from coronavirus disease 2019. ⋯ Despite multiple reports of mortality rates exceeding 50% among critically ill adults with coronavirus disease 2019, particularly among those requiring mechanical ventilation, our early experience indicates that many patients survive their critical illness.