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Critical Care Research and Practice

Fatih Aygun
Introduction: Procalcitonin (PCT) and C-reactive protein (CRP) are already known predictive markers in serious bacterial infections, and it is emphasized that these biomarkers can be used as a marker of increased mortality in critically ill patients. Herein, we aimed to evaluate the initial serum PCT and CRP levels on the outcome of patients in pediatric intensive care units (PICUs) and find out if these biomarkers can be used to predict mortality. Materials and Methods: The relationship between the initial serum PCT and CRP levels and invasive mechanical ventilation (IMV) and noninvasive mechanical ventilation (NIV) support, inotropic drug need, acute renal kidney injury (AKI), continuous renal replacement therapy (CRRT), mortality, and hospitalization period was investigated retrospectively...
2018: Critical Care Research and Practice
Wesley Henrique Bueno de Camargo, Rita de Cassia Pereira, Marcos T Tanita, Lidiane Heko, Isadora C Grion, Josiane Festti, Ana Luiza Mezzaroba, Cintia Magalhães Carvalho Grion
Purpose: To analyze whether a viscoelastic mattress support surface can reduce the incidence of stage 2 pressure injuries compared to a standard hospital mattress with pyramidal overlay in critically ill patients. Method: A randomized clinical trial with intention-to-treat analysis was carried out recruiting patients with Braden scale ≤14 on intensive care unit admission from April 2016 to April 2017. Patients were allocated into two groups: intervention group (viscoelastic mattress) and control group (standard mattress with pyramidal overlay)...
2018: Critical Care Research and Practice
Christopher Waters, R Constance Wiener, Hamed M Motlagh
Background: Secretions accumulate in endotracheal tubes' (ETT) lumens upon their placement in patients. The secretions impact airway resistance and pressure. Secretions potentiate prolonged mechanical ventilation and ventilator-associated pneumonia. Our primary objective in this study was to evaluate an ETT-clearing device (ETT-CD) in its ability to remove secretions from ex vivo ETT lumens. Methods: Forty ETTs, obtained from intensive care patients at extubation, were individually placed into a ventilator field performance testing simulator at 37°C...
2018: Critical Care Research and Practice
Ashlesha Kaushik, Helen Kest
Invasive fungal infections (IFIs) have seen considerable increase in pediatric intensive care units over the past several decades. IFIs are predominantly caused by Candida species, and candidemia is the third most common cause of healthcare-associated bloodstream infections (BSIs) in children. IFIs are opportunistic infections that affect pediatric patients in critical care resulting in significant morbidity and mortality especially in those with a compromised immune system. IFIs are the leading cause of death in children with comorbidities such as immunosuppression, and pediatric ICU admission has been shown to be an independent risk factor for mortality...
2018: Critical Care Research and Practice
Alberto A Leguina-Ruzzi, Rina Ortiz
There are strong data showing that malnutrition is highly prevalent in intensive care unit patients (20-50% in the worldwide), presenting a negative accumulated body energy balance. This results in an increased mortality, infections, and hospital length stay with high costs associated with the total treatment. Parenteral nutrition is the first option when the patient's physical condition is not suitable for oral nutrient intake. It is composed essentially by lipids as an energy source, metabolic, and structural function...
2018: Critical Care Research and Practice
Lulan Li, Zhongqing Chen, Weijun Fu, Shumin Cai, Zhenhua Zeng
Sepsis, a dysregulated host response to infection, is a major public health concern. Though experimental and clinical studies relating to sepsis are increasing, the mechanism of sepsis is not completely understood. To date, numerous studies have shown that sirtuins (silent mating type information regulation 2 homolog), which belong to the class III histone deacetylases, may have a varied, or even opposite, effect in the pathogenesis of sepsis. Notably, downstream mechanisms of sirtuins are not fully understood...
2018: Critical Care Research and Practice
Kimmie Clark, Taylor Leathers, Duncan Rotich, Jianghua He, Katy Wirtz, Emmanuel Daon, Brigid C Flynn
Objective: Frailty has been associated with adverse outcomes following cardiac surgery. Gait speed has been validated as a marker of frailty. Slow gait speed has been found to be associated with mortality after cardiac surgery. However, it is unknown why slow gait speed predisposes to cardiac surgical mortality. Design: A retrospective analysis. Participants: Patients undergoing cardiac surgery who had a 5-meter walk test performed preoperatively (n=333 of 1735 total surgical patients) from January 2013 to March 2017...
2018: Critical Care Research and Practice
Johannes Enevoldsen, Cristhian Potes, Minnan Xu-Wilson, Simon T Vistisen
Background: Extrasystoles may be useful for predicting the response to fluid therapy in hemodynamically unstable patients but their prevalence is unknown. The aim of this study was to estimate the availability of extrasystoles in intensive care unit patients diagnosed with sepsis. The study aim was not to validate the fluid responsiveness prediction ability of extrasystoles. Methods: Twenty-four-hour ECG recordings from a convenience sample of 50 patients diagnosed with sepsis were extracted from the MIMIC-II waveform database, and ECGs were visually examined for correct QRS complex detection...
2018: Critical Care Research and Practice
Claire Rimes-Stigare, Bo Ravn, Akil Awad, Klara Torlén, Claes-Roland Martling, Matteo Bottai, Johan Mårtensson, Max Bell
Background: Renal dysfunction after acute kidney injury (AKI) is common, potentially modifiable, but poorly understood. Acute kidney disease (AKD) describes renal dysfunction 7 to 90 days after AKI and is determined by percentage change in creatinine from baseline. Chronic kidney disease (CKD) is defined as the estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 persisting for more than 90 days. We compared CKD incidence using both creatinine- and cystatin C-based GFR with AKD incidence at 90 days in AKI survivors...
2018: Critical Care Research and Practice
Matthew Sczepanski, Paul Bozyk
Introduction: Tissue plasminogen activator (tPA) is commonly used in ischemic cerebral vascular accidents (CVAs). tPA is generally well tolerated; however, orolingual angioedema is a well-documented adverse effect. Angioedema is generally mild, transient, and unilateral but can manifest as severe, life-threatening upper airway obstruction requiring intubation. Reported incidence for all severities ranges from one to five percent, whereas reported incidence of severe cases ranges from 0...
2018: Critical Care Research and Practice
D Jochems, K J P van Wessem, R M Houwert, H B Brouwers, J W Dankbaar, M A van Es, M Geurts, A J C Slooter, L P H Leenen
Introduction: Traumatic brain injury (TBI) remains a major cause of death. Withdrawal of life-sustaining treatment (WLST) can be initiated if there is little anticipated chance of recovery to an acceptable quality of life. The aim of this study was firstly to investigate WLST rates in patients with moderate to severe isolated TBI and secondly to assess outcome data in the survivor group. Material and Methods: A retrospective cohort study was performed. Patients aged ≥ 18 years with moderate or severe isolated TBI admitted to the ICU of a single academic hospital between 2011 and 2015 were included...
2018: Critical Care Research and Practice
Peter M Reardon, Shannon M Fernando, Sasha Van Katwyk, Kednapa Thavorn, Daniel Kobewka, Peter Tanuseputro, Erin Rosenberg, Cynthia Wan, Brandi Vanderspank-Wright, Dalibor Kubelik, Rose Anne Devlin, Christopher Klinger, Kwadwo Kyeremanteng
Background: ICU care is costly, and there is a large variation in cost among patients. Methods: This is an observational study conducted at two ICUs in an academic centre. We compared the demographics, clinical data, and outcomes of the highest decile of patients by total costs, to the rest of the population. Results: A total of 7,849 patients were included. The high-cost group had a longer median ICU length of stay (26 versus 4 days, P < 0...
2018: Critical Care Research and Practice
Niels D Martin, Sagar P Patel, Kristen Chreiman, Jose L Pascual, Benjamin Braslow, Patrick M Reilly, Lewis J Kaplan
Background: Critically ill patients are often evaluated for an intra-abdominal catastrophe. In the absence of a preoperative diagnosis, abdominal exploration may be offered despite desperate circumstances. We hypothesize that (1) abdominal exploration for such patients is associated with a high mortality and (2) commonly obtained physiologic measures at laparotomy anticipate mortality. Methods: All acute care surgery (ACS) patients undergoing emergency laparotomy at a quaternary referral center during a 3-year period were reviewed...
2018: Critical Care Research and Practice
Nathan Murray, Utsav Malla, Ruan Vlok, Alice Scott, Olivia Chua, Thomas Melhuish, Leigh White
Introduction: In lab-based studies, buprenorphine appears to have a ceiling effect on respiratory depression but not on analgesia. There is increasing evidence in adult patients that buprenorphine has no ceiling effect on analgesia or side effects. The aim of this study was to investigate the efficacy and adverse effects of buprenorphine versus morphine in paediatric acute pain. Methods: A systematic review of five databases was performed until May 2018. Only randomised controlled trials were eligible for inclusion...
2018: Critical Care Research and Practice
Christos Lazaridis, Laith Altaweel, Dimitrios Karakitsos
No abstract text is available yet for this article.
2018: Critical Care Research and Practice
Gloria-Beatrice Wintermann, Jenny Rosendahl, Kerstin Weidner, Bernhard Strauß, Katja Petrowski
Objective: Major depressive disorder (MDD) is a common condition following treatment in the Intensive Care Unit (ICU). Long-term data on MDD in chronically critically ill (CCI) patients are scarce. Hence, the primary aim of the present study was to investigate the frequency and predictors of MDD after intensive care of CCI patients. Materials and Methods: In a prospective cohort study, patients with long-term mechanical ventilation requirements ( n =131) were assessed with respect to a diagnosis of MDD, using the Structured Clinical Interview for DSM-IV, three and six months after the transfer from acute ICU to post-acute ICU...
2018: Critical Care Research and Practice
Joost D J Plate, Linda M Peelen, Luke P H Leenen, Roderick M Houwert, Falco Hietbrink
Rationale , Aims , and Objectives . The Intermediate Care Unit (IMCU) is a hospital unit which is logistically situated between the hospital ward and the Intensive Care Unit (ICU). There is debate regarding the value of the IMCU. Understanding its value is compromised by the lack of adequate quality indicators. Therefore, this study identifies currently used IMCU indicators and evaluates their usefulness. Methods . Through a systematic literature search, currently used quality indicators were identified and evaluated for their importance using a proposed IMCU-specific quality measurement framework...
2018: Critical Care Research and Practice
Marcela Aparecida Leite, Erica Fernanda Osaku, Jaqueline Albert, Claudia Rejane Lima de Macedo Costa, Alessandra Madalena Garcia, Francieli do Nascimento Czapiesvski, Suely Mariko Ogasawara, Gladson Ricardo Flor Bertolini, Amaury Cezar Jorge, Péricles Almeida Delfino Duarte
Background: Deep and respiratory muscle disorders are commonly observed in critically ill patients. Neuromuscular electrical stimulation (NMES) is an alternative to mobilize and to exercise that does not require active patient participation and can be used on bedridden patients. Objective: Evaluate the effectiveness of the NMES therapy in quadriceps versus diaphragm subjects in mechanical ventilation (MV). Methods: Sixty-seven subjects in MV were included, divided into 3 groups: (a) control group (CG, n =26), (b) stimulation of quadriceps (quadriceps group-QG, n =24), and (c) stimulation of diaphragm (diaphragm group-DG, n =17)...
2018: Critical Care Research and Practice
Ibrahim Soliman, Waleed Tharwat Aletreby, Fahad Faqihi, Nasir Nasim Mahmood, Omar E Ramadan, Ahmad Fouad Mady, Babar Kahlon, Abdulrahman Alharthy, Peter Brindley, Dimitrios Karakitsos
Background: Dedicated neurocritical care units have dramatically improved the management and outcome following brain injury worldwide. Aim: This is the first study in the Middle East to evaluate the clinical impact of a neurocritical care unit (NCCU) launched within the diverse clinical setting of a polyvalent intensive care unit (ICU). Design and Methods: A retrospective before and after cohort study comparing the outcomes of neurologically injured patients...
2018: Critical Care Research and Practice
Alok Dabi, Aristides P Koutrouvelis
Direct oral anticoagulants (DOACs) are a new class of anticoagulants that directly inhibit either thrombin or factor Xa in the coagulation cascade. They are being increasingly used instead of warfarin or other vitamin K antagonists (VKAs). Adverse side effects of DOACs may result in hemorrhagic complications, including life-threatening intracranial hemorrhage (ICH), though to a much lesser degree than VKAs. Currently there are relatively limited indications for DOACS but their usage is certain to expand with the availability of their respective specific reversal agents...
2018: Critical Care Research and Practice
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