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CriticalCare

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14

Critical Care

Perioperative goal-directed therapy (PGDT) may improve postoperative outcome in high-risk surgery patients but its adoption has been slow. In 2012, we initiated a performance improvement (PI) project focusing on the implementation of PGDT during high-risk abdominal surgeries. The objective of the present study was to evaluate the effectiveness of this intervention.  
ccforum.com
almost 6 years ago
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4

Critical Care

Severe cardiovascular collapse (CVC) is a life-threatening complication after emergency endotracheal intubation (ETI) in the ICU. Many factors may interact with hemodynamic conditions during ETI, but no study to date has focused on factors associated with severe CVC occurrence. This study assessed the incidence of severe CVC after ETI in the ICU and analyzed the factors predictive of severe CVC.  
ccforum.com
almost 6 years ago
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10

Critical Care

We read with great interest the pilot study on fracture risk in 46 critically ill patients by Rawal and colleagues [1]. Bone mineral density (BMD) was assessed with portable calcaneal dual X-ray absorptiometry (DXA) on days 1 and 10. The authors found no overall change in BMD, but increased fracture risk in the subgroup with 'ARDS' (acute respiratory distress syndrome) (n = 34). There are several serious methodological problems: it is unclear if the group assignment is valid as only one of the four Berlin definition criteria [2] for the diagnosis of ARDS is given: oxygenation (no information on timing, chest imaging and origin of the edema). Although peripheral DXA devices are certainly an interesting option for BMD in critically ill and other patients [3], precision errors supplied by the manufacturer should not be used. In fact, each center must determine its (own) precision error and least significant change, which is also operator dependent [4]. The manufacturer stated a 0.9 % coefficient of variation, which is not necessarily applicable to the study setting where it remains unclear how the measurements were performed. This could be an important limitation. Hence, it is unlikely that a 2 % BMD change within such a short time frame as described would reflect anything else other than random variability. Lastly, it is also unclear what the described statistical difference refers to - it should be noted that the smaller subgroup (n = 12) numerically increased their BMD. Undoubtedly, fracture risk following critical illness is a very important topic that requires further high-quality studies [5].  
ccforum.com
almost 6 years ago
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28

Critical Care

Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered. The common operating room practice of sedation and neuromuscular blockade to facilitate intubation may carry significant risk in the ICU patient with a marked oxygenation abnormality, particularly when performed by the non-expert. Preoxygenation is largely ineffective in these patients and oxygen desaturation occurs rapidly on induction of anesthesia, limiting the time available to secure the airway. The ICU environment is less favorable for complex airway management than the operating room, given the frequent lack of availability of additional equipment or additional expert staff. ICU intubations are frequently carried out by trainees, with a lesser degree of airway experience. Even in the presence of a non-concerning airway assessment, these patients are optimally managed as a difficult airway, utilizing an awake approach. Endotracheal intubation may be achieved by awake direct laryngoscopy in the sick ICU patient whose level of consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the patient’s spontaneous respiratory efforts are not depressed by the administration of drugs, additional time is available to obtain equipment and expertise in the event of failure to secure the airway. ICU intubation complications should be tracked as part of the ICU quality improvement process.  
ccforum.com
almost 6 years ago
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7

Critical Care

Intraparenchymal, multimodality sensors are commonly used in the management of patients with severe traumatic brain injury (TBI). The ‘gold standard’, based on accuracy, reliability and cost for intracranial pressure (ICP) monitoring is within the cerebral ventricle (external strain gauge). There are no standards yet for intracerebral temperature monitoring and little is known of temperature differences between brain tissue and ventricle. The aim of the study therefore was to determine pressure and temperature differences at intraparenchymal and ventricular sites during five days of continuous neuromonitoring.  
ccforum.com
almost 6 years ago
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17

Critical Care

Tight glucose control therapy (TGC) has been implemented to control hyperglycemia in ICU patients. TGC may also influence serum potassium concentrations. We therefore investigated the influence of TGC on both serum glucose and serum potassium concentrations and associated mortality.  
ccforum.com
almost 6 years ago
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6

Critical Care

In this study, we evaluated the impacts of organ failure and residual dysfunction on 1-year survival and health care resource use using Intensive Care Unit (ICU) discharge as the starting point.  
ccforum.com
almost 6 years ago
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4

Critical Care

A chronic shortage of organs remains the main factor limiting organ transplantation. Many countries have explored the option of uncontrolled donation after circulatory death (uDCD) in order to expand the donor pool. Little is known regarding the variability of practices and outcomes between existing protocols. This systematic review addresses this knowledge gap informing policy makers, researchers, and clinicians for future protocol implementation.  
ccforum.com
almost 6 years ago
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8

Critical Care

Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) have been associated with reduced mortality and lower ICU-acquired bacteremia and ventilator-associated pneumonia rates in areas with low levels of antibiotic resistance. However, the effect of selective decontamination (SDD/SOD) in areas where multidrug-resistant Gram-negative bacteria are endemic is less clear. It will be important to determine whether SDD/SOD improves patient outcome in such settings and how these measures affect the epidemiology of multidrug-resistant Gram-negative bacteria. Here we review the current evidence on the effects of SDD/SOD on antibiotic resistance development in individual ICU patients as well as the effect on ICU ecology, the latter including both ICU-level antibiotic resistance and antibiotic resistance development during long-term use of SDD/SOD.  
ccforum.com
almost 6 years ago
10
2
71

Total impact of Intensive Care

This Dutch foundation 'Family and Patient Centered Intensive Care' (FCIC) www.fcic.nl - is widening the horizon of the focus on the impact of Intensive Care on the quality of life of patients. What is happening in this field in your region?  
Ruud Klerks
almost 6 years ago
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2

SMACCFORCE at Chicago

The best EMS, prehospital and retrieval workshop in 2015 is coming soon to Chicago. #SMACCFORCE. https://t.co/Swmtx5jF0n— brian burns (@HawkmoonHEMS) April 20, 2015 #SMACCFORCE will reunite old friendships from the #PHARM world and make many more new ones. #smaccUS https://t.co/EDEvFE09yE— brian burns (@HawkmoonHEMS) June 4, 2015 #Ultrasound essential in the critical care and retrieval of neonates @tisheewoods…  
prehospitalmed.com
almost 6 years ago