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1.
Thierry Boulain Isabelle RungeNicolas Bercault MD Dalila Benzekri-LefevreManuel Wolf MD Christian Fleury MD 《Journal of critical care》2009
Objective
The aim of this study is to examine the potential impact of dopamine therapy on 28-day mortality in adult septic shock.Methods
For 66 months, clinical data, medications taken before admission, doses of catecholamines used, and biological parameters were recorded prospectively in all patients admitted for septic shock. This observational study was followed by (1) post hoc multivariate analyses and (2) risk-adjusted matched cohort study.Measurements and main results
In 277 patients (65 ± 14 years; Simplified Acute Physiology Score II = 54 ± 19, 28-day mortality = 45%; hospital mortality = 53%), 6 factors were linked to 28-day mortality, including Simplified Acute Physiology Score II (P < .0001) and the use of dopamine (P = .043). In a pair-matched cohort of 132 patients, we observed a higher mortality with dopamine (28-day mortality of 62% vs 41%, respectively; P = .006). Dopamine remained linked to day 28 mortality by conditional logistic analysis (odds ratio = 6.2 [1.5-25]). A strong interaction between essential hypertension and dopamine was found, associated to 81% 28-day mortality in patients having both conditions.Conclusions
In our cohort study, dopamine use was linked to mortality as compared to other vasopressor therapies, particularly in patients with essential hypertension. Future randomized studies attempting to compare dopamine with other therapies in septic shock should pay attention to patients with essential hypertension. 相似文献2.
Berlot G Vassallo MC Busetto N Bianchi M Zornada F Rosato I Tartamella F Prisco L Bigotto F Bigolin T Ferluga M Batticci I Michelone E Borelli M Viviani M Tomasini A 《Journal of critical care》2012,27(2):167-171
Purpose
Because the use of IgM and IgA enriched polyclonal intravenous immunoglobulins (eIg) is a standard of care in critically ill patients admitted to our intensive care unit (ICU) with the diagnosis of severe sepsis or septic shock, we investigated if the delay from the onset of severe sepsis and septic shock and their administration could influence the outcome.Materials and Methods
The medical records of all patients with severe sepsis or septic shock admitted to our ICU from July 2004 through October 2009 and treated with eIg (Pentaglobin®; Biotest, Dreieich, Germany) were retrospectively examined.Results
A total of 129 adult patients with severe sepsis or septic shock were considered eligible. Thirty-two percent of patients died during the ICU stay. Survivors were given eIg significantly earlier than nonsurvivors (23 vs 63 hours, P < .05). The delay in the administration of eIg and the Simplified Acute Physiology Score II were the only variables that entered stepwise a propensity score-adjusted logistic model. The delay in the administration of eIg was a significant predictor of the odds of dying during the ICU stay (odds ratio for 1 hour of delay, 1.007; P < .01; 99% confidence interval from 1.001 to 1.010) and proved to be independent from the Simplified Acute Physiology Score II and other variables.Conclusions
The efficacy of eIg, being maximal in early phases of severe sepsis and/or septic shock, is probably time dependent. 相似文献3.
Purpose
Studies showing corticosteroids decrease time to shock reversal in septic shock did not include arginine vasopressin, which also may reduce the duration of catecholamine therapy. Thus, the effect of corticosteroids on vasopressin-containing vasopressor regimens is unknown. We designed this study to evaluate the effect of corticosteroids on time to vasopressin-containing vasopressor withdrawal and the proportion of patients alive without vasopressors at day 7.Methods
This retrospective, case-control study included patients admitted to the intensive care units of an academic medical center who received vasopressin-containing vasopressor regimens for septic shock with or without concomitant corticosteroids. Twenty-one corticosteroid-treated patients were matched to those without corticosteroids.Results
Both groups had similar Acute Physiology And Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores. There was no significant difference in median time to vasopressor withdrawal (65 hours vs 20 hours, P = .09) whether corticosteroids were given or withheld. Patients who received corticosteroids, however, were significantly more likely alive without vasopressors at day 7 than patients who received a vasopressin-containing vasopressor regimen alone (80.9% vs 47.6%, P = .02).Conclusions
Although corticosteroids did not improve the time to withdrawal of vasopressin-containing vasopressor therapy they significantly increased the proportion of patients alive without vasopressors at day 7. 相似文献4.
Stéphane Gaudry MD Jean-Damien Ricard Clément Leclaire Cédric Rafat Jonathan Messika Alexandre BedetDavid Hajage MD Didier Dreyfuss 《Journal of critical care》2014
Purpose
Renal replacement therapy (RRT) is a major supportive treatment of acute kidney injury (AKI) in intensive care unit (ICU), but the timing of its initiation remains open to debate.Materials and methods
We retrospectively analyzed ICU patients who had AKI associated with at least one usual RRT criteria: serum creatinine concentration greater than 300 μmol/L, serum urea concentration greater than 25 mmol/L, serum potassium concentration greater than 6.5 mmol/L, severe metabolic acidosis (arterial blood pH < 7.2), oliguria (urine output < 135 mL/8 hours or < 400 mL/24 hours), overload pulmonary edema. To estimate the risk of death associated with RRT adjusted for risk factors, we performed a marginal structural Cox model with inverse-probability-of-treatment-weighted estimator.Results
Among 4173 patients admitted to the ICU, 203 patients fulfilled potential RRT criteria. Ninety-one patients (44.8%) received RRT and 112 (55.2%) did not. Non-RRT and RRT patients differed in terms of severity of illness: Simplified Acute Physiology Score II (55 ± 17 vs 60 ± 19, respectively; P < .05) and Sequential Organ Failure Assessment score (8 [5-10] vs 9 [7-11], respectively; P = .01).Crude analysis indicated a lower ICU mortality for non-RRT compared with RRT patients (18% vs 45%; P < .001). In the marginal structural Cox model, RRT was associated with increased mortality (P < .01).Conclusion
A conservative approach of AKI was not associated with increased mortality. 相似文献5.
Ching-Chi Lee Hsiang-Chin Hsu Chia-Ming Chang Ming-Yuan Hong Wen-Chien Ko 《The American journal of emergency medicine》2013
Objective
The objective was to compare the clinical characteristics of elderly and young adult patients with dengue in the emergency department (ED).Methods
Demographic characteristics, clinical presentation, disease severity, laboratory characteristics, and outcomes were analyzed prospectively as a case-control study.Results
Of the 193 adults with serologically confirmed dengue disease in 2007, 31 (16.1%) were elderly patients (aged ≥ 65) and 162 were young adults (aged < 65). More dengue hemorrhagic fever (12.9% vs 2.5%, P = .02), a longer ED stay (13.3 vs 8.6 hours, P = .004), a longer hospital stay (7.4 vs 3.4 days, P < .001), a higher Simplified Acute Physiology Score II in the ED (29.7 vs 17.4, P < .001), and a higher rate of at least 1 comorbidity (61.8 vs 22.8%, P < .001) were found in the elderly. However, the length of the intensive care unit stay (elderly 0.7 vs young adults 0.3 day, P = .47) and the 14-day mortality rate (0% vs 0.6%, P = 1.00) were similar. Of note, in terms of clinical presentations of dengue in the ED, there were more elderly patients with isolated fever (41.9% vs 17.9%, P = .003) and fewer with typical presentation (41.9% vs 75.9%, P = < .001) than there were young adults.Conclusions
The present study found a higher number of atypical presentations, a longer hospitalization, and a higher degree of clinical illness in elderly patients with dengue. 相似文献6.
Ho Cheol Kim Jun-Wan Yoo So Yeon Lim Gee Young Suh Shin Ok Koh Sungwon Na Chae-Man Lim Younsuck Koh Won-Il Choi Young-Joo Lee Seok Chan Kim Chin Kook Rhee Gyu Rak Chon Je Hyeong Kim Jae Yeol Kim Jaemin Lim Sunghoon Park Jin Hwa Lee Ji Hyun Lee 《Journal of critical care》2013
Purpose
The purpose of this study is to evaluate factors associated with the mortality of patients admitted to intensive care units (ICUs) after in-hospital cardiopulmonary resuscitation (CPR) and the impact of a hospital rapid response system (RRS) on patient mortality in Korea.Materials and Methods
A prospective multicenter cohort study was done in 22 ICUs of 15 centers from July 1, 2010, to January 31, 2011. We only enrolled patients admitted to ICUs after in-hospital CPR and divided eligible patients into 2 groups—survivors and nonsurvivors.Results
Among 4617 patients, 150 patients were admitted post-CPR, 76 died, and 74 survived. At 24 hours, the Sequential Organ Failure Assessment score, Simplified Acute Physiology Score II, and the best Glasgow Coma Scale were significantly lower in the nonsurvivors than in the survivors. In multivariate analysis, the Simplified Acute Physiology Score II and presence of lower respiratory infection were both independently associated with mortality. At the first hour after admission, lowest serum potassium and highest heart rate were associated with mortality. At 24 hours after admission, lowest mean arterial pressure, HCO3 level, and venous oxygen saturation level; highest heart rate; and use of vasoactive drugs were associated with mortality. The mortality of patients in hospitals with an RRS was not significantly different from that of hospitals without an RRS.Conclusion
Various physiologic and laboratory parameters were associated with the mortality of post-CPR ICU admitted patients, and the presence of an RRS did not reduce mortality of these patients in our study. 相似文献7.
Thomas Weig Silke Janitza Michael Zoller Michael E. Dolch Jens Miller Lorenz Frey Nikolaus Kneidinger Thorsten Johnson Mirjam I. Schubert Michael Irlbeck 《Journal of critical care》2014
Purpose
Obesity is a worldwide pandemic, and obese patients face an increased risk of developing acute respiratory distress syndrome (ARDS). Prone positioning (PP) is a frequently used intervention in the treatment of ARDS. There are no data describing the impact of PP on morbidity and mortality in abdominally obese patients. We report our observations in abdominally obese ARDS patients treated with PP.Materials and methods
Patients with ARDS (n = 82) were retrospectively divided into 2 groups characterized by presence (n = 41) or absence (n = 41) of abdominal obesity as defined by a sagittal abdominal diameter of 26 cm or more.Results
There was no difference in cumulative time abdominally obese patients were placed in prone position from admission to day 7 (41.0 hours [interquartile range, 50.5 hours] vs 39.5 hours [interquartile range, 61.5 hours]; P = .65) or in overall intensive care unit mortality (34% vs 34%; P = 1). However, abdominally obese patients developed renal failure (83% vs 35%; P < .001) and hypoxic hepatitis (22% vs 2%; P = .015) more frequently. A significant interaction effect between abdominal obesity and prone position with respect to mortality risk (likelihood ratio, P = .0004) was seen if abdominally obese patients were treated with prolonged cumulative PP.Conclusion
A cautious approach to PP should be considered in abdominally obese patients. 相似文献8.
Tiruvoipati R Chiezey B Lewis D Ong K Villanueva E Haji K Botha J 《Journal of critical care》2012,27(2):153-158
Background
Stress hyperglycemia (SH) is commonly seen in critically ill patients. It has been shown to be associated with adverse outcomes in some groups of patients. The effects of SH on critically ill patients with sepsis have not been well studied. We aimed to evaluate the effects of SH in critically ill patients with sepsis.Methods
In this retrospective study, patients with sepsis admitted to intensive care unit (ICU) over a 5-year period were included.Results
Of 297 patients, 204 (68.7%) had SH during the study period. The mean blood glucose level in patients with SH was 8.7 mmol/L compared with 5.9 mmol/L in those without SH (P < .05). There were no statistically significant differences in age; sex; sepsis severity; cardiovascular, respiratory, and renal comorbidities; requirement of mechanical ventilation; inotropes; and Acute Physiology, Age, and Chronic Health Evaluation III and Simplified Acute Physiology 2 scores on ICU admission. Intensive care unit mortality was significantly lower in patients who had SH. The median duration of ICU and hospital length of stay was longer in patients with SH. On logistic regression analysis, the presence of SH was associated with reduced ICU mortality. Subgroup analysis revealed SH to be protective in patients with septic shock.Conclusion
Stress hyperglycemia may not be harmful in critically ill patients with sepsis. Patients with SH had lower ICU mortality. 相似文献9.
Objective
The objective of the study is to determine the 28-day mortality of critically ill cancer patients with acute respiratory distress syndrome (ARDS).Design
This is a retrospective cohort study of patients enrolled in the ARDS Network randomized controlled trials.Results
A total of 2515 patients did not have cancer, and 116 patients had cancer. Patients with cancer were older (median, 61 vs 49 years; P < .0001), more critically ill (the median Acute Physiology and Chronic Health Evaluation III score without cancer comorbidity was 105 for the cancer group compared with 87 for those without cancer; P < 0.0001), and more likely to have pneumonia or sepsis as cause of acute lung injury (79.31% vs 62.70%; P = .0011). The overall mortality at day 28 was 25.7%. Patients with cancer had significantly higher mortality (55.2%) compared with those without cancer (24.3%) (P < .0001). The odds ratio for mortality from ARDS at 28 days for cancer patients was 2.54 (95% confidence interval [CI], 1.570-4.120). Acute Physiology and Chronic Health Evaluation III score and age were found to be significant predictors of outcome in cancer patients with odds ratio of 1.034 (95% CI, 1.007-1.062; P = .0135) and 1.075 (95% CI, 1.024-1.129, P = .0036), respectively.Conclusions
Cancer patients with ARDS have a significantly higher risk of death compared with those without cancer. The increased risk appeared to be mediated by increased severity of illness at presentation, as well as by age. 相似文献10.
Rishi Sikka Supriya Mehta Carleen Kaucky Erik B. Kulstad 《The American journal of emergency medicine》2010
Objective
We measured the correlation between emergency department (ED) occupancy rate and time to antibiotic administration for patients with pneumonia treated in a community hospital setting.Methods
We reviewed quality improvement data on patients treated for pneumonia in our ED and admitted over a 5-month period. The outcomes were timeliness of antibiotic therapy (within 4 hours of arrival) and overall time to antibiotic administration. Emergency department crowding was measured as the ED occupancy rate. We calculated (1) the Spearman correlation between occupancy rate at time of patient presentation and the time to antibiotic administration, (2) the odds ratio of receiving antibiotics within 4 hours with increasing ED occupancy, and (3) the ability of the occupancy rate to predict failure of achieving the 4-hour goal with the receiver operating characteristic curve.Results
A total of 334 patients were treated over the study period, of which 262 had complete data available. Occupancy rate ranged from 20% to 245%, and median was 137%. Eighty-one percent received antibiotics within 4 hours; the median time was 150 minutes. Time to antibiotics showed a positive correlation with occupancy rate (Spearman ρ = 0.17, P = .008). An increasing ED occupancy rate was associated with decreased odds of receiving antibiotics within 4 hours (odds ratio, 0.31; 95% confidence interval, 0.13-0.75). Receiver operating characteristic curve area was 0.62 (95% confidence interval, 0.54-0.70; P = .009).Conclusion
Emergency department occupancy rate was associated with increased time to antibiotic treatment for patients admitted with pneumonia. Occupancy rate had fair success in predicting failure of treatment within 4 hours. 相似文献11.
Jijo John D. Bradley Woodward Yanping Wang S. Betty Yan Diana Fisher Gary T. Kinasewitz Darell Heiselman 《Journal of critical care》2010
Purpose
The purpose of this retrospective study was to evaluate cardiac troponin-I (cTnI) as a 28-day mortality prognosticator and predictor for a drotrecogin alfa (activated) (DrotAA) survival benefit in recombinant human activated Protein C Worldwide Evaluation in Severe Sepsis patients.Methods
Cardiac troponin-I was measured using the Access AccuTnI Troponin I assay (Beckman Coulter, Fullerton, CA). There were 598 patients (305 DrotAA, 293 placebo) with baseline cTnI data (cTnI negative [<0.06 ng/mL], n = 147; cTnI positive [≥0.06 ng/mL], n = 451).Results
Cardiac troponin-I–positive patients were older (mean age, 61 vs 56 years; P = .002), were sicker (mean Acute Physiology and Chronic Health Evaluation II, 26.1 vs 22.3; P < .001), had lower baseline protein C levels (mean level, 49% vs 56%; P = .017), and had higher 28-day mortality (32% vs 14%, P < .0001) than cTnI-negative patients. Elevated cTnI was an independent prognosticator of mortality (odds ratio, 2.020; 95% confidence interval, 1.153-3.541) after adjusting for other significant variables. Breslow-Day interaction test between cTnI levels and treatment was not significant (P = .65).Conclusion
This is the largest severe sepsis study reporting an association between elevated cTnI and higher mortality. Cardiac troponin-I elevation was not predictive of a survival benefit with DrotAA treatment. 相似文献12.
Introduction
Ventilator-associated pneumonia (VAP) is difficult to diagnose. Recent data suggest quantitative endotracheal aspirate (ETA) may be noninferior diagnostically to quantitative bronchoalveolar lavage (BAL). We hypothesized this would be the case.Methods
Blind quantitative ETA and BAL were performed on 150 consecutive ventilated patients with suspected VAP in a prospective single-centre medical intensive care unit study over a 2-year inclusion period. Patients were either antibiotic-naive or antibiotic-free for 72 hours. Diagnostic yield, Gram stain and culture results, and impact on antibiotic therapy were assessed. The independent impact of a positive BAL or ETA result on ventilator settings and 28-day mortality was calculated. The BAL/ETA safety was assessed hemodynamically.Results
Bronchoalveolar lavage had significantly higher diagnostic yield (49.3% vs 34.0%, P = .01), more frequent impact on antibiotic therapy (usually de-escalation) (48.0% vs 32.7%, P = .01), and greater sensitivity (64.1% vs 42.6%, P = .0003) than ETA. There was moderate intertest agreement and no difference in specificity and positive and negative predictive values. A positive BAL or ETA result did not independently alter the frequency of ventilator changes or 28-day mortality. Both procedures were well tolerated.Conclusion
Quantitative BAL is safe and has greater diagnostic utility than ETA for VAP facilitates de-escalation. This study provides support for quantitative BAL in VAP diagnosis. 相似文献13.
Massimo Zambon Marcello Ceola Roberto Almeida-de-Castro Antonino Gullo Jean-Louis Vincent 《Journal of critical care》2008
Purpose
The aim of this study is to evaluate the feasibility of applying sepsis bundles in the intensive care unit (ICU) and their effect on outcomes.Methods
In this prospective, observational study in a 31-bed capacity department of intensive care, we measured the time taken to perform sepsis bundle interventions in 69 consecutive patients with severe sepsis or septic shock.Results
Compliance with the 6-hour bundle was obtained in 44 (72%) of 61 patients; these patients had a lower mortality rate (16% vs 41%, P = .04) and shorter ICU stay (median [range], 5 [3-10] vs 9 [6-19] days, P = .01) than other patients. Compliance with the 24-hour bundle was obtained in 30 (67%) of 44 eligible patients. The mortality rate and duration of ICU stay were not significantly lower in the 24-hour compliant as compared with the noncompliant group (23% vs 33% and 6 [4-11] vs 9 [6-25] days, respectively; P value is not significant). Patients who complied with the 24-hour sepsis bundle after only 12 hours had a lower mortality rate (10% vs 39%, P = .036) and shorter stay (6 [4-10] vs 9 [6-25] days, P = .055) than those who were compliant after 24 hours.Conclusions
Correct application of the sepsis bundles was associated with reduced mortality and length of ICU stay. Earlier implementation of the 24-hour management bundle could result in better outcomes. 相似文献14.
Anthony M. Nicasio Kathryn J. Eagye David P. Nicolau Eric Shore Marc Palter Judith Pepe Joseph L. Kuti 《Journal of critical care》2010
Background
Because of the high frequency of multidrug resistant bacteria in our intensive care units (ICUs), we implemented a ventilator-associated pneumonia (VAP) clinical pathway based on unit-specific minimum inhibitory concentration (MIC) distributions and pharmacodynamic modeling in 3 of our ICUs.Methods
This was a prospective, observational evaluation with a historical control group in adult patients (n = 168) who met clinical and radiologic criteria for VAP. Monte Carlo simulation was used to determine antibiotic regimens having the greatest likelihood of achieving bactericidal exposures against Pseudomonas aeruginosa. Antibiotic regimens were incorporated into an ICU-specific computerized clinical pathway as empiric agents of choice.Results
Pharmacodynamic modeling found 3-hour infusions of cefepime 2 g every 8 hours or meropenem 2 g every 8 hours plus tobramycin and vancomycin would provide the greatest probability of empirically treating VAP in these ICUs. Infection-related mortality was reduced by 69% (8.5% vs 21.6%; P = .029), infection-related length of stay was shorter (11.7 ± 8.1 vs 26.1 ± 18.5; P < .001), and fewer superinfections were observed in patients treated on the pathway. A number of patients with nonsusceptible P aeruginosa were successfully treated with high-dose, 3-hour infusion regimens.Conclusions
In our ICUs where multidrug resistant bacteria are common, an approach considering ICU-specific antibiotic MICs coupled with pharmacodynamic dosing strategies resulted in improved outcomes and shorter duration of treatments. 相似文献15.
Noha M. Elsharnouby Hala E.A. Eid Nahla F. Abou Elezz Yasser A. Aboelatta 《Journal of critical care》2014
Purpose
Nebulized heparin may reduce fibrin cast formation and reduce the degree of airway obstruction in burn inhalation injury.Methods
Twenty-nine patients admitted to burn intensive care unit (ICU) within 24 hours of burn inhalation injury were included in this prospective double-blinded randomized study. Group H5 received nebulized heparin sulfate 5,000 IU, and group H10 received nebulized heparin sulfate 10,000 IU. Heparin was given in alternation with N-acetylcysteine every 2 hours. Lung injury score assessed daily for 7 days was the primary outcome. Duration of mechanical ventilation, coagulation profile, length of ICU stay, and mortality were the secondary outcomes.Results
Median lung injury scores were significantly lower in group H10 on days 5 (1.9 vs 1), 6 (1.4 vs 0.5), and 7 (1.3 vs 0.5). Group H10 had also a lower duration of mechanical ventilation than did group H5 (P = .037). The groups had no significant difference in coagulation parameters, length of ICU stay (P = .17), and mortality (P = .6).Conclusions
Nebulized heparin 10,000 IU decreased lung injury scores and duration of mechanical ventilation but had no effect on length of ICU stay and mortality. Moreover, nebulized heparin 10,000 IU was safe and had no effect on coagulation parameters. 相似文献16.
Shiqi WangXiangying Feng MD Shujun LiChaoxu Liu MD Bin XuBin Bai MD Pengfei YuQuanxin Feng MD Qingchuan Zhao 《Journal of critical care》2014
Purpose
The purpose of this study is to investigate the accuracy of currently used scoring systems in differentiating transient and persistent organ failure in patients with acute pancreatitis (AP).Materials and methods
In this retrospective study, 127 consecutive patients with AP and organ failure were included. Patients were divided into transient and persistent organ failure groups. The Acute Physiology and Chronic Health Examination II score, bedside index of severity in acute pancreatitis, harmless acute pancreatitis score, and modified Marshall scores within the first 24 hours of organ failure were collected, and their accuracy in predicting transient organ failure was assessed.Results
Transient organ failure occurred in 46 patients (36.2%). Fewer patients with transient organ failure initiated with multiple organ failure (13.0% vs 37.0%, P = .004) and renal failure (17.4% vs 44.4%, P = .002). In predicting transient organ failure, the area under the curves of the 4 scoring systems is from 0.66 to 0.71. The area under the curve of serum amylase was 0.78, which was slightly better than that of the modified Marshall and Acute Physiology and Chronic Health Examination II score and was significantly better than that of the bedside index of severity in acute pancreatitis and harmless acute pancreatitis score (P < .05).Conclusions
Current scoring systems are not accurate enough in differentiating transient and persistent organ failure in patients with AP. 相似文献17.
Miano TA Powell E Schweickert WD Morgan S Binkley S Sarani B 《Journal of critical care》2012,27(1):45-50
Introduction
Delayed administration of effective antimicrobial therapy increases mortality in patients with septic shock. Empiric antibiotic selection in this setting can be inaccurate. The objective of this study was to determine whether an antibiotic algorithm (AA) tailored to institutional resistance patterns improves the adequacy of antimicrobial therapy.Methods
A retrospective review of our rapid response system database was performed. Patients with possible sepsis with positive microbiological culture results were enrolled. Pathogens identified by culture were used to determine adequacy of antibiotic selection before and after implementation of an AA.Results
A total of 234 patients with septic shock were reviewed (before AA, n = 36; after AA, n = 198). Seventy-two patients had positive cultures and were enrolled (before AA, n = 13; after AA, n = 59). Significantly more patients received adequate coverage after AA implementation (54% vs 86%, P = .02). Before AA, inadequate Gram-negative coverage was the most common reason for failure. Reasons for failure in the after-AA group were nonadherence to the algorithm (n = 5) and multidrug-resistant pathogens (n = 3). The algorithm failed in patients with vancomycin-resistant enterococci (n = 3), multidrug-resistant Klebsiella pneumoniae (n = 1), and Candida albicans (n = 1).Conclusions
The use of an AA significantly improves the adequacy of empiric antimicrobial therapy. 相似文献18.
Johann Reisinger Kurt HöllingerWolfgang Lang MD Christoph SteinerThomas Winter MD Andreas WinterMichael Mori MD Alexander LindorferDaniel Kiblböck MD Peter Siostrzonek MD 《The American journal of emergency medicine》2009
Objective
Existing data indicate that selenium supplementation may be beneficial in critically ill patients and in those with ischemic stroke. The purpose of this retrospective study was to explore the influence of early administration of selenium on neurological outcome after cardiopulmonary resuscitation (CPR).Methods
We examined 227 consecutive unconscious patients after CPR and excluded 1 individual. The decision to administer selenium was left to the discretion of the attending physician, resulting in 124 patients (55%) who received intravenous selenium (200-1000 μg/d) for a median of 5 days after CPR. Patients were classified according to the best Glasgow-Pittsburgh cerebral performance categories (CPCs 1-5) achieved within 6 months of follow-up.Results
The rate of regaining consciousness (CPC 1-3) after CPR was 58%. Multivariable logistic regression analysis confirmed a shockable first monitored rhythm (adjusted odds ratio, 3.73; 95% confidence interval, 1.85-7.52; P < .001), time to return of spontaneous circulation (adjusted odds ratio, 0.94; 95% confidence interval, 0.91-0.96; P < .001), administration of selenium (adjusted odds ratio, 2.38; 95% confidence interval, 1.19-4.76; P = .014), and the Simplified Acute Physiology Score II (adjusted odds ratio, 0.96; 95% confidence interval, 0.93-0.99; P = .034) as independent predictors of regaining consciousness after CPR. Survival at 6 months of follow-up was not improved significantly by selenium.Conclusion
This retrospective analysis leads to the hypothesis that early administration of selenium may improve neurological outcome after cardiac arrest. 相似文献19.
Ching-Chi Lee Chia-Ming Chang Ming-Yuan Hong Hsiang-Chin Hsu Wen-Chien Ko 《The American journal of emergency medicine》2013
Objectives
To investigate the clinical impact of age on bacteremia among adults visiting the emergency department (ED).Methods
Bacteremic adults visiting the ED from January 2008 to December 2008 were identified retrospectively. Demographic characteristics, severity, bacteremic pathogens with in vitro susceptibility, antimicrobial agents, and outcomes determined from chart records were analyzed as a case-control study.Results
Of 518 eligible bacteremic adults, 288 (55.6%) elderly patients (≥ 65 years old) were case patients and 230 younger patients (< 65 years) were regarded as control patients. The 28-day mortality rate was higher in the case patients than that in the control patients (11.8% vs 6.1%, P = .02). The proportion of inappropriate empirical antibiotic therapy between the survivors and nonsurvivors was similar in control patients (69.4% vs 64.3%, P = .77); but for the case patients, the proportion of inappropriate empirical antibiotic therapy in the survivors was lower than that in the non-survivors (27.6% vs 44.1%, P = .04). Of note, inappropriate empirical antibiotic therapy was also one of independent risk factors of 28-day mortality by the multivariate analyses in the case patients (odds ratio [OR] 3.65; P = .049). Other independent predictors of 28-day mortality in case patients included a high Pittsburgh bacteremia score (≥ 4 points; OR 22.16; P < .001), bacteremia due to foci other than urinary tract infection (OR 9.07; P = .002), malignancy (OR 10.87; P < .001), coronary artery disease (OR 5.68; P = .01), and high serum creatinine (> 1.5 mg/dL; OR 3.44; P = .04).Conclusions
For bacteremic adults, this study demonstrated the impact of inappropriate empirical antibiotic therapy on patients’ outcome in the elderly was greater than that in the younger adults. 相似文献20.
Antonio Paulo Nassar Jr. Fernanda Maria Queiroz da Silva Roberto de Cleva 《Journal of critical care》2009