Chest
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Multicenter Study Comparative Study Clinical Trial
Pressure-support ventilation versus T-piece during spontaneous breathing trials before extubation among patients at high-risk of extubation failure: a post-hoc analysis of a clinical trial.
Spontaneous breathing trial (SBT) using a T-piece remains the most frequently performed trial before extubation in ICUs. ⋯ In patients at high risk of extubation failure in the ICU, performing an initial SBT using PSV may hasten extubation without an increased risk of reintubation.
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Review
Teaching Clinical Reasoning and Critical Thinking: From Cognitive Theory to Practical Application.
Teaching clinical reasoning is challenging, particularly in the time-pressured and complicated environment of the ICU. Clinical reasoning is a complex process in which one identifies and prioritizes pertinent clinical data to develop a hypothesis and a plan to confirm or refute that hypothesis. Clinical reasoning is related to and dependent on critical thinking skills, which are defined as one's capacity to engage in higher cognitive skills such as analysis, synthesis, and self-reflection. ⋯ In addition, the article describes how internal and external factors in the clinical environment can affect students' and trainees' clinical reasoning abilities, as well as their capacity to understand and incorporate strategies for effective critical thinking into their practice. Utilizing applicable cognitive psychological theory, the relevant literature on teaching clinical reasoning is reviewed, and specific strategies to effectively teach clinical reasoning and critical thinking in the ICU and other clinical settings are provided. Definitions, operational descriptions, and justifications for a variety of teaching interventions are discussed, including the "one-minute preceptor" model, the use of concept or mechanism maps, and cognitive de-biasing strategies.
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Bronchoscopy is a useful tool for the diagnosis of lesions near central airways; however, the diagnostic accuracy of these procedures for peripheral pulmonary lesions (PPLs) is a matter of ongoing debate. In this setting, electromagnetic navigation bronchoscopy (ENB) is a technique used to navigate and obtain samples from these lesions. This systematic review and meta-analysis aims to explore the sensitivity of ENB in patients with PPLs suspected of lung cancer. ⋯ ENB is very safe with good sensitivity for diagnosing malignancy in patients with PPLs. The applicability of our findings is limited because most studies were done with the superDimension navigation system and heterogeneity was high.