Chest
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Multicenter Study
Surrogate decision makers' responses to physicians' predictions of medical futility.
Although physicians sometimes use the futility rationale to limit the use of life-sustaining treatments, little is known about how surrogate decision makers view this rationale. We sought to determine the attitudes of surrogates of patients who are critically ill toward whether physicians can predict futility and whether these attitudes predict surrogates' willingness to discontinue life support when faced with predictions of futility. ⋯ Doubt about physicians' ability to predict medical futility is common among surrogate decision makers. The nature of the doubt may have implications for responding to conflicts about futility in clinical practice.
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Patients in the ICU are known to have severely disrupted sleep with disturbed circadian pattern, decreased nocturnal sleep time, abnormally increased stages 1 and 2 sleep, and reduced or absent deep sleep. Recent data reveal that a subpopulation of critically ill patients manifests unique EEG sleep patterns. ⋯ How sleep disruption contributes to outcomes in critically ill patients, such as recovery time and weaning from mechanical ventilation, is unknown. This article reviews the literature describing sleep in ICU patients, including recent investigations in patients who require mechanical ventilation, factors that affect sleep in critically ill patients, and the potential mechanisms and clinical implications of disturbed sleep in the ICU setting with directions to consider for future investigations.
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Multicenter Study
Mortality probability model III and simplified acute physiology score II: assessing their value in predicting length of stay and comparison to APACHE IV.
To develop and compare ICU length-of-stay (LOS) risk-adjustment models using three commonly used mortality or LOS prediction models. ⋯ APACHE IV and MPM(0) III were more accurate than SAPS II for the prediction of ICU LOS. APACHE IV is the most accurate and best calibrated model. Although it is less accurate, MPM(0) III may be a reasonable option if the data collection burden or the treatment effect bias is a consideration.
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Randomized Controlled Trial
Endobronchial ultrasonography-guided transbronchial needle aspiration increases the diagnostic yield of peripheral pulmonary lesions: a randomized trial.
The diagnostic yield of endobronchial ultrasonography (EBUS)-guided transbronchial needle aspiration (TBNA) for peripheral pulmonary lesions (PPLs) has not been evaluated. The diagnostic impact of TBNA when the EBUS probe is adjacent to lesions remains to be determined. ⋯ Applying TBNA to EBUS-guided CDPs further increased the diagnostic yield of PPLs without additional risk. The diagnostic advantage of TBNA became more obvious if the EBUS probe was adjacent to the lesions.
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Controlled Clinical Trial
Diagnostic and prognostic values of pleural fluid procalcitonin in parapneumonic pleural effusions.
The role of procalcitonin (PCT) in parapneumonic pleural effusion (PPPE) as a diagnostic and prognostic biomarker of the outcome has not been examined before. ⋯ S-PCT has higher diagnostic accuracy than PF-PCT in differentiating PPPEs from non-PPPEs. However, both PF-PCT and S-PCT are useful in the severity assessment of patients with PPPEs. The PF-PCT/S-PCT ratio may help to predict prolonged chest tube drainage.