Explore the vast range of titles available.

The past decade has witnessed growth in the long-term acute care (LTAC) hospital industry. There are no reliable risk assessment models that can adjust outcomes across such facilities with different criteria for admitting patients. Variation in reported outcomes makes it difficult to determine whether a patient, or group of patients, may benefit from such care. This study sought to determine the extent to which survival in the LTAC setting is associated with age, race, residual organ system failures (OSFs), or APACHE (acute physiology and chronic health evaluation) III scores at the time of admission to LTAC. Retrospective medical record review. Four freestanding facilities of a LTAC hospital. A sample of 300 hospital admissions weighted to represent the study hospital population. Inpatient survival modeled as a function of age, APACHE III score calculated within 72 h prior to LTAC admission, and residual OSFs present on admission to LTAC. Logistic regression analysis shows age and OSF were most predictive of inpatient survival (receiver operating characteristic curve area = 0.81). APACHE III score was not predictive of survival in the multivariate model. Survival in LTAC is primarily associated with age and OSFs, which should be used to adjust for patient populations among LTAC settings when comparing outcomes. Our model identifies a group of patients with the poorest likelihood of survival in the LTAC setting, and may be used to facilitate dialogue with patients and family in cases where continued aggressive care is least effective.

In a randomized trial involving 4000 patients in the ICU who required sedation for mechanical ventilation, dexmedetomidine had no benefit on 90-day mortality as compared with usual care and was associated with more adverse events. Additional drugs were required for prescribed sedation levels in the two groups.

In this cluster-randomized, multiple-crossover trial conducted in 5 ICUs, intravenous administration of balanced crystalloids resulted in a lower rate of the composite outcome — death from any cause, new renal-replacement therapy, or persistent renal dysfunction — than saline.

This randomized, double-blind trial involving critically ill patients compared balanced multielectrolyte solution with saline as fluid therapy in the ICU. There was no evidence that the risk of death or acute kidney injury was lower with the use of BMES than with saline.

This trial involving critically ill adults receiving mechanical ventilation compared the effects of energy-dense and routine enteral nutrition. The use of an energy-dense formulation did not increase the rate of survival at 90 days.

In a multicenter trial in 566 patients with critical illness who had delirium, the use of haloperidol or ziprasidone, as compared with placebo, had no significant effect on the duration of delirium or coma. Side effects and extrapyramidal disorders occurred at similar rates in all groups.

In this multicenter randomized, controlled trial, withholding parenteral nutrition from critically ill children in the pediatric intensive care unit for 1 week was clinically superior to providing early parenteral nutrition. Fluid loading was provided in both groups. Critically ill children cannot normally be fed by mouth, and as a result a pronounced macronutrient deficit often develops after a few days. This macronutrient deficit has been associated with infections, weakness, prolonged mechanical ventilation, and delayed recovery. 1 – 3 In order to prevent or limit the development of this macronutrient deficit, current guidelines, which are based largely on small studies with surrogate end points and on expert opinion, advise care providers to initiate nutritional support soon after a child’s admission to the pediatric intensive care unit (ICU). 4 – 6 The preferred route for the administration of nutritional support in the pediatric . . .

In a randomized trial comparing the proton-pump inhibitor pantoprazole with placebo in the ICU, there was no significant difference in the rate of death at 90 days or in a combined end point of clinically meaningful events, which included gastrointestinal bleeding and pneumonia.

The appropriate caloric goal for critically ill adults is unclear. In this study, enteral feeding to deliver a moderate amount of nonprotein calories was not associated with lower mortality than that associated with planned delivery of a full amount of nonprotein calories. Nutritional support is an essential component of the care of critically ill adults. 1 Achieving caloric targets has been recommended with the premise that attenuating malnutrition and protein catabolism, which are associated with increased morbidity and mortality, will improve outcomes. 2 Observational studies examining various doses of enteral feeding have yielded conflicting results. 3 – 7 Two cluster-randomized, controlled trials comparing higher enteral nutritional delivery with usual care in critically ill patients showed no reduction in mortality with the higher enteral nutrition. 8 , 9 Augmenting energy intake with early parenteral nutrition has been shown to result in no change in mortality 10 and in an increased . . .

In a large, blinded, randomized trial involving critically ill adults, no significant difference in 90-day mortality was noted between those who received red cells stored for a mean of 11.8 days and those who received red cells stored for a mean of 22.4 days.