1,152 results match your criteria Journal of Intensive Care Medicine[Journal]


Wells and Geneva Scores Are Not Reliable Predictors of Pulmonary Embolism in Critically Ill Patients: A Retrospective Study.

J Intensive Care Med 2018 Dec 16:885066618816280. Epub 2018 Dec 16.

4 Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Background:: Critically ill patients are at high risk for pulmonary embolism (PE). Specific PE prediction rules have not been validated in this population. The present study assessed the Wells and revised Geneva scoring systems as predictors of PE in critically ill patients. Read More

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December 2018

Authors' Response to the Intensive Care Unit Discharge Delay and In-Hospital Mortality.

J Intensive Care Med 2018 Dec 11:885066618816686. Epub 2018 Dec 11.

2 Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.

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December 2018

The Role of Inflammatory Cytokines in Cardiac Arrest.

J Intensive Care Med 2018 Dec 10:885066618817518. Epub 2018 Dec 10.

1 Resuscitation Research Group, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.

Introduction:: Post-cardiac arrest syndrome (PCAS) is characterized by systemic ischemia/reperfusion injury, anoxic brain injury, and post-arrest myocardial dysfunction superimposed on a precipitating pathology. The role of inflammatory cytokines in cardiac arrest remains unclear.

Aims:: We aimed to describe, with an emphasis on clinical applications, what is known about the role of inflammatory cytokines in cardiac arrest. Read More

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December 2018

Are Health-Care Providers Well Prepared in Providing Optimal End-of-Life Care to Critically Ill Patients? A Cross-Sectional Study at a Tertiary Care Hospital in the United States.

J Intensive Care Med 2018 Dec 3:885066618811794. Epub 2018 Dec 3.

4 Department of Pulmonary and Critical Care Medicine, Northwell Health Staten Island University Hospital, Staten Island, NY, USA.

It is important for health-care providers to be comfortable in providing end-of-life (EOL) care to critically ill patients and realizing when continuing aggressive measures would be futile. Therefore, there is a need to understand health-care providers' self-perceived skills and barriers to providing optimum EOL care. A total of 660 health-care providers from medicine and surgery departments were asked via e-mail to complete an anonymous survey assessing their self-reported EOL care competencies, of which 238 responses were received. Read More

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December 2018

Intensive Care Unit Discharge Delay and In-Hospital Mortality.

J Intensive Care Med 2018 Dec 4:885066618816673. Epub 2018 Dec 4.

2 Department of Critical Care Medicine, Northeast Georgia Health System, Gainesville, GA, USA.

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December 2018

Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa.

J Intensive Care Med 2018 Dec 4:885066618815804. Epub 2018 Dec 4.

8 Pietermaritzburg Department of Anaesthesia, Critical Care and Pain Management, Pietermaritzburg, South Africa.

Objective:: To measure the association of intensive care unit (ICU) capacity strain with processes of care and outcomes of critical illness in a resource-limited setting.

Methods:: We performed a retrospective cohort study of 5332 patients referred to the ICUs at 2 public hospitals in South Africa using the country's first published multicenter electronic critical care database. We assessed the association between multiple ICU capacity strain metrics (ICU occupancy, turnover, census acuity, and referral burden) at different exposure time points (ICU referral, admission, and/or discharge) with clinical and process of care outcomes. Read More

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December 2018

Management Strategies for Intracranial Pressure Crises in Subarachnoid Hemorrhage.

J Intensive Care Med 2018 Dec 4:885066618813073. Epub 2018 Dec 4.

4 Department of Neurology, Division of Neuroendovascular Surgery and Neurocritical Care, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Objectives: Standard management strategies for lowering intracranial pressure (ICP) in traumatic brain injury has been well-studied, but the use of lesser known interventions for ICP in subarachnoid hemorrhage (SAH) remains elusive. Searches were performed in PubMed and EBSCO Host to identify best available evidence for evaluation and management of medically refractory ICP in SAH. The role of standard management strategies such as head elevation, hyperventilation, mannitol and hypertonic saline as well as lesser known management such as sodium bicarbonate, indomethacin, tromethamine, decompressive craniectomy, decompressive laparotomy, hypothermia, and barbiturate coma are reviewed. Read More

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December 2018
1 Read

Bedside Ultrasound Assessment of Lung Reaeration in Patients With Blunt Thoracic Injury Receiving High-Flow Nasal Cannula Oxygen Therapy: A Retrospective Study.

J Intensive Care Med 2018 Dec 4:885066618815649. Epub 2018 Dec 4.

1 Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Background:: High-flow nasal cannula (HFNC) oxygen therapy has been shown to reduce the need for mechanical ventilation and decrease the duration of hospital and intensive care unit (ICU) stays for patients with a severely compromised respiratory system. This study aims to observe the evolution of lung aeration via lung ultrasound score (LUS) in a chest-injured population who had been treated with HFNC oxygen therapy, and to assess the benefit of the HFNC oxygen therapy in trauma patients.

Methods:: A retrospective study examined trauma patients with moderate to severe thoracic injuries who were admitted to the ICU at a tertiary hospital between October 2015 and March 2017. Read More

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December 2018
1 Read

Devices to Reduce the Volume of Blood Taken for Laboratory Testing in ICU Patients: A Systematic Review.

J Intensive Care Med 2018 Nov 27:885066618810374. Epub 2018 Nov 27.

1 Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Background:: Intensive care unit (ICU) patients are at high risk of anemia, which is associated with adverse clinical outcomes and death. Blood sampling for diagnostic testing is a potentially modifiable contributor to anemia.

Methods:: We conducted a systematic review by searching MEDLINE and EMBASE from inception to October 5, 2017, for studies reporting the volume of blood taken for laboratory testing using blood sampling conservation devices compared to standard care or another intervention in adult ICU patients. Read More

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November 2018

Clinical Predictors for Unsafe Direct Discharge Home Patients From Intensive Care Units.

J Intensive Care Med 2018 Nov 26:885066618811810. Epub 2018 Nov 26.

1 Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

Purpose:: To describe factors (demographics and clinical characteristics) that predict patients who are at an increased risk of adverse events or unplanned return visits to a health-care facility following discharge direct to home (DDH) from intensive care units (ICUs).

Methods:: Prospective cohort study of all adult patients who survived their stay in our medical-surgical-trauma ICU between February 2016 and 2017 and were discharged directly home. Patients were followed for 8 weeks postdischarge. Read More

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November 2018
2 Reads

Prevalence and Predictors of Deep Vein Thrombosis in Critically Ill Medical Patients Who Underwent Diagnostic Duplex Ultrasonography.

J Intensive Care Med 2018 Nov 19:885066618813300. Epub 2018 Nov 19.

2 Department of Pulmonary and Critical Care Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

Introduction:: Deep vein thrombosis (DVT) is a recognized but preventable cause of morbidity and mortality in the medical intensive care unit (MICU). We examined the prevalence and risk factors for DVT in MICU patients who underwent diagnostic venous duplex ultrasonography (DUS) and the potential effect on clinical outcomes.

Methods:: This is a retrospective study examining prevalence of DVT in 678 consecutive patients admitted to a tertiary care level academic MICU from July 2014 to 2015. Read More

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November 2018
3 Reads

Interhospital Transfer of Children in Septic Shock: A Clinician Interview Qualitative Study.

J Intensive Care Med 2018 Dec 14;33(12):671-679. Epub 2016 Dec 14.

2 Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA.

Objective:: To determine the factors that influence the decision to transfer children in septic shock from level II to level I pediatric intensive care unit (PICU) care.

Design:: Interviews with level II PICU physicians in Michigan and Northwest Ohio. A hypothetical scenario of a 14-year-old boy in septic shock was presented. Read More

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http://dx.doi.org/10.1177/0885066616683662DOI Listing
December 2018
3 Reads

Cytomorphometric Neutrophil and Monocyte Markers May Strengthen the Diagnosis of Sepsis.

J Intensive Care Med 2018 Dec 13;33(12):656-662. Epub 2016 Dec 13.

2 Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India.

Background:: The diagnosis of sepsis is challenging in the absence of a gold standard test. Recent studies have explored the role of neutrophil and monocyte volume, conductivity, and scatter (VCS), derived from automated hematology analyzers, in diagnosing sepsis. We assessed the diagnostic accuracy of VCS parameters in critically ill patients with sepsis. Read More

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http://dx.doi.org/10.1177/0885066616682940DOI Listing
December 2018

BiPAP Noninvasive Ventilation in Patients With Acute Heart Failure and Left Ventricular Systolic Dysfunction Without Control of Confusing Variables.

J Intensive Care Med 2018 12;33(12):695-696

1 Facultad de Ciencias Médicas, Universidad de Guayaquil, Ciudadela Universitaria Salvador Allende, Malecón del Salado entre Av Fortunato Safadi (Av Delta) y Av. Kennedy, Guayaquil, Guayas 090513, Ecuador.

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http://dx.doi.org/10.1177/0885066618758616DOI Listing
December 2018
1 Read

Oncologic Emergencies-The Old, the New, and the Deadly.

J Intensive Care Med 2018 Nov 9:885066618803863. Epub 2018 Nov 9.

1 Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Cancer continues to be a leading cause of death despite a broader understanding of its biology and the development of novel therapies. Nonetheless, with an increasing survival of this population, intensivists must be aware of the associated emergencies, both old and new. Oncologic emergencies can be seen as an initial presentation of the disease or precipitated by its treatment. Read More

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November 2018
5 Reads

Management of Hemophagocytic Lympho-Histiocytosis in Critically Ill Patients.

J Intensive Care Med 2018 Nov 1:885066618810403. Epub 2018 Nov 1.

1 Medical ICU, AP_HP Saint Louis hospital, Paris, France.

Hemophagocytic syndrome remains a rare but life-threatening complication and is associated with intensive care unit (ICU) admission. The pathophysiology is based on a defect of cytotoxicity in T cells that results in a state of hyperinflammation in the presence of a trigger. As a consequence, patients may develop multiorgan failure. Read More

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November 2018
1 Read

Effects of Early Enteral Nutrition on Immune Function and Prognosis of Patients With Sepsis on Mechanical Ventilation.

J Intensive Care Med 2018 Nov 1:885066618809893. Epub 2018 Nov 1.

1 Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.

Objective:: To explore the therapeutic effects of early enteral nutrition (EEN) on patients with sepsis on mechanical ventilation.

Methods:: Patients with sepsis on mechanical ventilation in the medical intensive care unit (ICU) from January 2013 to March 2016 were treated with enteral nutrition. Patients treated within 48 hours of initiation of mechanical ventilation were assigned to the EEN group, and the rest were assigned to the delayed enteral nutrition (DEN) group. Read More

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http://journals.sagepub.com/doi/10.1177/0885066618809893
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November 2018
3 Reads

Relationship Between Near-Infrared Spectroscopy-Derived Cerebral Oxygenation and Delirium in Critically Ill Patients: A Systematic Review.

J Intensive Care Med 2018 Oct 30:885066618807399. Epub 2018 Oct 30.

1 Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.

Background:: A common neurological complication of critical illness is delirium, defined as an acute change in level of consciousness, with impaired attention and disorganized thinking. Patients with delirium have increased risk of long-term cognitive dysfunction and mortality. The cause is unknown, which limits our ability to design therapeutic interventions. Read More

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October 2018
1 Read

The Accuracy of Urinary TIMP-2 and IGFBP7 for the Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis.

J Intensive Care Med 2018 Oct 30:885066618807124. Epub 2018 Oct 30.

1 Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Province, PR China.

Background:: Tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) are recent promising markers for identification of cardiac surgery-associated acute kidney injury (CSA-AKI). The aim of this study was systematically and quantitatively to evaluate the accuracy of urinary TIMP-2 and IGFBP7 for the diagnosis of CSA-AKI.

Methods:: Three databases including PubMed, ISI web of knowledge, and Embase were systematically searched from inception to March 2018. Read More

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October 2018
9 Reads

Safety and Efficacy of Intermittent Bolus and Continuous Infusion Neostigmine for Acute Colonic Pseudo-Obstruction.

J Intensive Care Med 2018 Oct 29:885066618809010. Epub 2018 Oct 29.

1 Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, TX, USA.

Purpose:: To compare clinical response of intermittent bolus versus continuous infusion neostigmine for acute colonic pseudo-obstruction (ACPO). Acute colonic pseudo-obstruction occurs due to reduced colonic parasympathetic activity. Neostigmine is an acetylcholinesterase inhibitor that increases frequency of smooth muscle contraction by increasing acetylcholine at autonomic nervous system synapses. Read More

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October 2018
8 Reads

Prevalence and Risk Factors for Augmented Renal Clearance in a Population of Critically Ill Patients.

J Intensive Care Med 2018 Oct 29:885066618809688. Epub 2018 Oct 29.

1 Department of Intensive Care, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.

Background:: Critically ill patients show a high, albeit variable, prevalence of augmented renal clearance (ARC). This condition has relevant consequences on the elimination of hydrophilic drugs. Knowledge of risk factors for ARC helps in the early identification of ARC. Read More

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October 2018

Right Heart Thrombi: Patient Outcomes by Treatment Modality and Predictors of Mortality: A Pooled Analysis.

J Intensive Care Med 2018 Oct 29:885066618808193. Epub 2018 Oct 29.

7 Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, NY, USA.

Rationale:: Right heart thrombi (RiHT) is characterized by the presence of thrombus within the right atrium or right ventricle (RV). Current literature suggests pulmonary embolism (PE) with RiHT carries a high mortality. Guidelines lack recommendations in managing RiHT. Read More

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http://dx.doi.org/10.1177/0885066618808193DOI Listing
October 2018
11 Reads

Portable Ventilation/Perfusion Scanning is Useful for Evaluating Clinically Significant Pulmonary Embolism in the ICU Despite Abnormal Chest Radiography.

J Intensive Care Med 2018 Oct 22:885066618807859. Epub 2018 Oct 22.

1 Pulmonary & Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Objective:: Computed tomography angiography is limited in the intensive care unit (ICU) due to renal insufficiency, hemodynamic instability, and difficulty transporting unstable patients. A portable ventilation/perfusion (V/Q) scan can be used. However, it is commonly believed that an abnormal chest radiograph can result in a nondiagnostic scan. Read More

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October 2018
3 Reads

Perceived Barriers to Mobility in a Medical ICU: The Patient Mobilization Attitudes & Beliefs Survey for the ICU.

J Intensive Care Med 2018 Oct 18:885066618807120. Epub 2018 Oct 18.

1 Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Purpose: Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated Patient Mobilization Attitudes & Beliefs Survey (PMABS) for the ICU setting and evaluated its performance characteristics and results.

Materials And Methods: The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU. Read More

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October 2018
4 Reads

Anesthesiologist and Emergency Medicine Physician Attitudes and Knowledge Regarding Etomidate for Intubation.

J Intensive Care Med 2018 Oct 18:885066618804989. Epub 2018 Oct 18.

2 Department of Medicine, Western University, London, Ontario, Canada.

Purpose: The use of etomidate as an induction agent for critically ill patients is controversial. While its favorable hemodynamic profile is enviable, etomidate has been shown to cause transient adrenal suppression. The clinical consequences of transient adrenal suppression are poorly understood. Read More

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October 2018

Authors' Response.

J Intensive Care Med 2018 Oct 18:885066618803883. Epub 2018 Oct 18.

1 Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

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October 2018

The ART of Antiretroviral Therapy in Critically Ill Patients With HIV.

J Intensive Care Med 2018 Oct 11:885066618803871. Epub 2018 Oct 11.

1 Avera McKennan Hospital & University Health Center, Sioux Falls, SD, USA.

The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions. Read More

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October 2018
1 Read

Don't Sugar Coat It: Glycemic Control in the Intensive Care Unit.

J Intensive Care Med 2018 Oct 11:885066618801748. Epub 2018 Oct 11.

1 Department of Anesthesiology & Critical Care Medicine, Critical Care Medicine Service, Memorial Sloan Kettering Cancer Center, NY, USA.

Stress hyperglycemia is the transient increase in blood glucose as a result of complex hormonal changes that occur during critical illness. It has been described in the critically ill for nearly 200 years; patient harm, including increases in morbidity, mortality, and lengths of stay, has been associated with hyperglycemia, hypoglycemia, and glucose variability. However, there remains a contentious debate regarding the optimal glucose ranges for this population, most notably within the past 15 years. Read More

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http://dx.doi.org/10.1177/0885066618801748DOI Listing
October 2018
9 Reads

Pharmacologic Management of Delirium in the ICU: A Review of the Literature.

J Intensive Care Med 2018 Oct 11:885066618805965. Epub 2018 Oct 11.

3 Department of Pharmacy, Pharmacy and Therapeutics, UPMC Presbyterian Hospital, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.

Purpose: Conflicting data exists on the pharmacologic management of intensive care unit (ICU) delirium. This review appraises the current evidence of pharmacologic management of ICU delirium.

Materials And Methods: A systematic literature search of MEDLINE and Embase was conducted to answer the population, intervention, comparison, and outcome (PICO) question of: "Does the use of a pharmacologic agent compared to standard of care or placebo improve ICU delirium in a critically ill patient population?"

Results: After application of the PICO question and the inclusion and exclusion criteria, 13 articles were included. Read More

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October 2018
11 Reads

Dynamic Assessment of Fluid Responsiveness in Surgical ICU Patients Through Stroke Volume Variation is Associated With Decreased Length of Stay and Costs: A Systematic Review and Meta-Analysis.

J Intensive Care Med 2018 Oct 11:885066618805410. Epub 2018 Oct 11.

2 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Static indices, such as the central venous pressure, have proven to be inaccurate predictors of fluid responsiveness. An emerging approach uses dynamic assessment of fluid responsiveness (FT-DYN), such as stroke volume variation (SVV) or surrogate dynamic variables, as more accurate measures of volume status. Recent work has demonstrated that goal-directed therapy guided by FT-DYN was associated with reduced intensive care unit (ICU) mortality; however, no study has specifically assessed this in surgical ICU patients. Read More

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October 2018
18 Reads

The Impact of Chronic Ozone and Particulate Air Pollution on Mortality in Patients With Sepsis Across the United States.

J Intensive Care Med 2018 Oct 7:885066618804497. Epub 2018 Oct 7.

1 Division of Critical Care Medicine, Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

Objective: The impact of chronic exposure to air pollution on mortality in patients with sepsis is unknown. We attempted to quantify the relationship between air pollution, notably excess ozone, and particulate matter (PM), with in-hospital mortality in patients with sepsis nationwide.

Methods: The 2011 Nationwide Inpatient Sample (NIS) was linked with ambient air pollution data from the Environmental Protection Agency for both 8-hour ozone exposure and annual mean 2. Read More

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October 2018
4 Reads

Effect of Magnesium Loading Dose on Insulin Resistance in Patients With Stress-Induced Hyperglycemia: A Randomized Clinical Trial.

J Intensive Care Med 2018 Oct 7:885066618803866. Epub 2018 Oct 7.

3 Section of Metabolic and Vascular Medicine, Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany.

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http://dx.doi.org/10.1177/0885066618803866DOI Listing
October 2018

Reply to "Contemporary Management of the High-Risk Pulmonary Embolism: The Clot Thickens".

Authors:
Seth Lotterman

J Intensive Care Med 2018 Oct 7:885066618804983. Epub 2018 Oct 7.

1 Department of Emergency Medicine, Hartford Hospital, Hartford, CT, USA.

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October 2018
2 Reads

Shock Index-A Useful Noninvasive Marker Associated With Age-Specific Early Mortality in Children With Severe Sepsis and Septic Shock: Age-Specific Shock Index Cut-Offs.

J Intensive Care Med 2018 Oct 2:885066618802779. Epub 2018 Oct 2.

1 Department of Pediatrics, King George's Medical University, Lucknow, India.

Background: Aim of the study was to analyze the association of shock index (SI) from 0 to 6 hours with early mortality in severe sepsis/septic shock and to explore its age-specific cut-off values. To investigate association of change in SI over first 6 hours with early mortality.

Methods: A prospective cohort study of children (<14 years) admitted in emergency department, tertiary care hospital with severe sepsis or septic shock, divided into 3 groups: group 1: 1 month to <1 year; group 2: 1 to <6 years; group 3: 6 to 12 years. Read More

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October 2018
1 Read

Authors' Response.

J Intensive Care Med 2018 Oct 1:885066618803862. Epub 2018 Oct 1.

1 Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

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October 2018

Target Temperature Management May Not Improve Clinical Outcomes of Extracorporeal Cardiopulmonary Resuscitation.

J Intensive Care Med 2018 Oct 1:885066618801269. Epub 2018 Oct 1.

1 Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Purpose: Target temperature management (TTM) and extracorporeal cardiopulmonary resuscitation (ECPR) have been established as important interventions during cardiopulmonary arrest. However, the impact of combined TTM and ECPR on clinical outcomes has not been studied in detail.

Methods: We reviewed the records of 245 patients who received extracorporeal life support (ECLS) between January 2012 and June 2015. Read More

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October 2018
12 Reads

Impact of Intensive Care Unit Discharge Delays on Patient Outcomes: A Retrospective Cohort Study.

J Intensive Care Med 2018 Oct 1:885066618800276. Epub 2018 Oct 1.

2 Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.

Objective: Patients often overstay in intensive care units (ICU) after they are deemed discharge ready. The objective of this study was to examine the impact of such discharge delays (DD) on subsequent in-hospital morbidity and mortality.

Design: Retrospective cohort study. Read More

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October 2018
1 Read

Effect of Low-Dose Hydrocortisone Therapy in Adult Patients With Septic Shock: A Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials.

J Intensive Care Med 2018 Oct 1:885066618803062. Epub 2018 Oct 1.

1 Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, People's Republic of China.

Background: The efficacy of low-dose hydrocortisone therapy in the management of septic shock remains controversial in critical care for many years. Hence, we performed this meta-analysis of randomized controlled trials (RCTs) with trial sequential analysis (TSA) to evaluate its effect on clinical outcome among adult patients with septic shock.

Methods: We identified relevant RCTs published from inception to March 7, 2018 comparing low-dose hydrocortisone with placebo or no intervention in adults admitted to the intensive care unit (ICU) for septic shock. Read More

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October 2018
1 Read

Chronic Comorbid Illnesses Predict the Clinical Course of 866 Patients Requiring Prolonged Mechanical Ventilation in a Long-Term, Acute-Care Hospital.

J Intensive Care Med 2018 Oct 1:885066618783175. Epub 2018 Oct 1.

3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York City, NY, USA.

Objective: To determine whether burdens of chronic comorbid illnesses can predict the clinical course of prolonged mechanical ventilation (PMV)patients in a long-term, acute-care hospital (LTACH).

Methods: Retrospective study of 866 consecutive PMV patients whose burdens of chronic comorbid illnesses were quantified using the Cumulative Illness Rating Scale (CIRS). Based on increasing CIRS scores, 6 groups were formed and compared: group A (≤25; n = 97), group B (26-28; n = 105), group C (29-31; n = 181), group D (32-34; n = 208), group E (35-37; n = 173), and group F (>37; n = 102). Read More

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http://dx.doi.org/10.1177/0885066618783175DOI Listing
October 2018
5 Reads

Vitamin D Deficiency Is Highly Prevalent in Critically Ill Patients and a Risk Factor for Mortality: A Prospective Observational Study Comparing Noncirrhotic Patients and Patients With Cirrhosis.

J Intensive Care Med 2018 Oct 1:885066618803844. Epub 2018 Oct 1.

1 2nd Medical Department, Klinikum rechts der Isar, Technical University Munich, München, Germany.

Introduction: A 25-hydroxyvitamin D, 25(OH)D, deficiency is common among critically ill patients and correlated with increased mortality. Furthermore, deficiency is associated with advanced liver disease. However, there are no studies available comparing the dimensions and consequences of a 25(OH)D deficiency between patients with and without liver cirrhosis in the setting of intensive care units (ICUs). Read More

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http://dx.doi.org/10.1177/0885066618803844DOI Listing
October 2018
2 Reads

Effects From Continuous Infusions of Dexmedetomidine and Propofol on Hemodynamic Stability in Critically Ill Adult Patients With Septic Shock.

J Intensive Care Med 2018 Sep 27:885066618802269. Epub 2018 Sep 27.

1 Department of Pharmacy, Rush University Medical Center, Chicago, IL, USA.

Purpose: To compare the development of clinically significant hemodynamic event (ie, hypotension or bradycardia) in adults with septic shock receiving either propofol or dexmedetomidine.

Materials And Methods: A retrospective cohort study of adults with septic shock admitted to an intensive care unit (ICU) at an academic medical center between July 2013 and July 2017.

Results: Patients in the propofol (n = 35) and dexmedetomidine (n = 37) groups developed a clinically significant hemodynamic event at similar frequencies (31. Read More

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http://dx.doi.org/10.1177/0885066618802269DOI Listing
September 2018
6 Reads

Evaluation of the Use of Low-Dose 4-Factor Prothrombin Complex Concentrate in the Reversal of Direct Oral Anticoagulants in Bleeding Patients.

J Intensive Care Med 2018 Sep 24:885066618800657. Epub 2018 Sep 24.

1 Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, TX, USA.

Objective: This study investigated the percentage of patients who achieved hemostasis with 4-factor prothrombin complex concentrate (4-factor PCC) 35 U/kg. The primary end point was to determine the effect of 4-factor PCC 35 U/kg on bleeding progression, assessed using computed tomography.

Methods: This was a retrospective, observational, single-center study conducted in patients with a major bleed admitted to a level 1 trauma center from May 1, 2013, to June 15, 2015, who received 4-factor PCC 35 U/kg for reversal of a direct factor Xa inhibitor taken prior to admission. Read More

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http://journals.sagepub.com/doi/10.1177/0885066618800657
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http://dx.doi.org/10.1177/0885066618800657DOI Listing
September 2018
29 Reads

Bronchoscope-Guided Percutaneous Endoscopic Gastrostomy Tube Placement by Interventional Pulmonologists: A Feasibility and Safety Study.

J Intensive Care Med 2018 Sep 24:885066618800275. Epub 2018 Sep 24.

3 Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Background: Percutaneous endoscopic gastrostomy (PEG) tube placement is a procedure frequently done in the intensive care unit. The use of a traditional endoscope can be difficult in cases of esophageal stenosis and theoretically confers an increased risk of infection due to its complex architecture. We describe a technique using the bronchoscope, which allows navigation through stenotic esophageal lesions and also minimizes the risk of endoscopy-associated infections. Read More

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http://dx.doi.org/10.1177/0885066618800275DOI Listing
September 2018
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Invasive Fungal Disease in Critically Ill Patients at High Risk: Usefulness of Lymphocyte Subtyping.

J Intensive Care Med 2018 Sep 19:885066618800690. Epub 2018 Sep 19.

1 Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.

Objectives: This study aimed to investigate the distinguishing ability of lymphocyte subtyping for diagnosis and prognosis of invasive fungal disease (IFD).

Methods: We assessed lymphocyte subtyping and evaluated the quantitative changes in key immunological parameters at intensive care unit (ICU) admission in critically ill patients at high risk and their potential influence on diagnosis and outcome of IFD. The primary outcome was 28-day mortality. Read More

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http://dx.doi.org/10.1177/0885066618800690DOI Listing
September 2018
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Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions.

J Intensive Care Med 2018 Sep 19:885066618795126. Epub 2018 Sep 19.

4 Department of General Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.

Background: Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients.

Methods: A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center. Read More

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http://dx.doi.org/10.1177/0885066618795126DOI Listing
September 2018
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Percutaneous Cannulation for Extracorporeal Life Support in Severely and Morbidly Obese Patients.

J Intensive Care Med 2018 Sep 19:885066618801547. Epub 2018 Sep 19.

1 Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.

Background: Extracorporeal life support systems are well-established devices for treating patients with acute cardiopulmonary failure. Severe or morbid obesity may result in complications such as limb ischemia, bleeding, unsuccessful cannulation, or infection at the cannulation sites. This article reports on our experience with cannulation and associated complications in severely and morbidly obese patients. Read More

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http://dx.doi.org/10.1177/0885066618801547DOI Listing
September 2018
2 Reads

Global Longitudinal Strain Using Speckle-Tracking Echocardiography in Sepsis.

J Intensive Care Med 2018 Sep 11:885066618799636. Epub 2018 Sep 11.

1 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.

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http://dx.doi.org/10.1177/0885066618799636DOI Listing
September 2018
6 Reads

Data Abstraction Error in Systematic Review of Global Longitudinal Strain Using Speckle-Tracking Echocardiography as a Mortality Predictor in Sepsis.

J Intensive Care Med 2018 Sep 11:885066618799638. Epub 2018 Sep 11.

2 Divison of Cardiology, University of Massachusetts Medical School, Worcester, MA, USA.

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http://dx.doi.org/10.1177/0885066618799638DOI Listing
September 2018
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Multimodality Monitoring in Neurocritical Care: Decision-Making Utilizing Direct And Indirect Surrogate Markers.

J Intensive Care Med 2018 Sep 11:885066618788022. Epub 2018 Sep 11.

1 Division of Neuroendovascular Surgery and Neurocritical Care, Department of Neurology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Substantial progress has been made to create innovative technology that can monitor the different physiological characteristics that precede the onset of secondary brain injury, with the ultimate goal of intervening prior to the onset of irreversible neurological damage. One of the goals of neurocritical care is to recognize and preemptively manage secondary neurological injury by analyzing physiologic markers of ischemia and brain injury prior to the development of irreversible damage. This is helpful in a multitude of neurological conditions, whereby secondary neurological injury could present including but not limited to traumatic intracranial hemorrhage and, specifically, subarachnoid hemorrhage, which has the potential of progressing to delayed cerebral ischemia and monitoring postneurosurgical interventions. Read More

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http://dx.doi.org/10.1177/0885066618788022DOI Listing
September 2018
1 Read