Journal of critical care
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Journal of critical care · Feb 2014
Review Meta AnalysisFluid resuscitation with hydroxyethyl starches in patients with sepsis is associated with an increased incidence of acute kidney injury and use of renal replacement therapy: A systematic review and meta-analysis of the literature.
Fluid resuscitation is a key intervention in sepsis, but the type of fluids used varies widely. The aim of this meta-analysis is to determine whether resuscitation with hydroxyethyl starches (HES) compared with crystalloids affects outcomes in patients with sepsis. ⋯ Fluid resuscitation practice with HES as in the meta-analyzed studies is associated with increased an increase in AKI incidence, need of RRT, RBC transfusion, and 90-day mortality in patients with sepsis. Therefore, we favor the use of crystalloids over HES for resuscitation in patients with sepsis.
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Journal of critical care · Feb 2014
Prediction of delirium in critically ill patients with elevated C-reactive protein.
Delirium is thought to be associated with systemic inflammatory response. However, its association with the most widely used inflammatory biomarker C-reactive protein (CRP) has not been well established. We aimed to examine whether CRP on intensive care unit (ICU) entry was associated with subsequent development of delirium. ⋯ C-reactive protein measured on ICU entry and its changes within 24 hours are risk indicators of delirium. Further studies exploring the treatment of delirium according to CRP levels are warranted.
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Journal of critical care · Feb 2014
Intensive care specialists' knowledge, attitudes, and professional use of published research evidence: A mail-out questionnaire survey of appropriate use of research evidence in clinical practice.
This survey investigates the knowledge, attitudes, and use of published research in clinical practice by intensive care specialists. ⋯ Respondents reported generally positive attitudes toward using published research evidence, in clinical practice; however, room for improvement in technical knowledge relating to published research evidence was noted.
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Journal of critical care · Feb 2014
Review Meta AnalysisSelenium supplementation in critically ill patients: A systematic review and meta-analysis.
The oxidative stress is recognized as a constant feature in critical illness. Nevertheless, the use of antioxidant therapy remains controversial. We tried to demonstrate that intravenous selenium supplementation could promote antioxidant status and help protect against infection and organ failure, improving outcome in critically ill patients. ⋯ The use of high-dose selenium might be associated with a beneficial effect on 28-day mortality in critically ill patients. Nevertheless, the use of selenium as adjuvant therapy needs further evaluations.
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Journal of critical care · Feb 2014
ReviewEchocardiography in the use of noninvasive hemodynamic monitoring.
Invasive pulmonary artery catheter measurements are the standard method for assessment of hemodynamic evaluation at the present time. However, this invasive approach is associated with an increase in patient morbidity and without evidence of a reduction in mortality. ⋯ Most of these measurements are easily obtained and provide a safe alternative to invasive hemodynamic assessment. As Doppler echocardiography is able to provide additional valuable information, such as cardiac systolic and diastolic function, and the presence of pericardial and pleural effusions, which can play a significant role in the patients' hemodynamic status, using this noninvasive modality in the daily practice for hemodynamic assessment can prove an alternative to invasive measures in selected patients as well as a complementary tool for those still in need of invasive monitoring.