Intensive care medicine
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Intensive care medicine · Nov 2024
Randomized Controlled TrialLow-dose clonidine infusion to improve sleep in postoperative patients in the high-dependency unit. A randomised placebo-controlled single-centre trial.
Dexmedetomidine increases sleep and reduces delirium in postoperative patients, but it is expensive and requires a monitored environment. Clonidine, another α 2-agonist, is cheaper and is used safely for other purposes in wards. We assessed whether clonidine would improve sleep in postoperative high-dependency unit (HDU) patients. ⋯ Among postoperative elective surgical patients admitted to HDU, low-dose non-titrated clonidine, compared to placebo, was associated with longer and subjectively better-quality sleep.
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Intensive care medicine · Nov 2024
Multicenter StudyCentral venous catheter-related infection: does insertion site still matter? A French multicentric cohort study.
We aim to evaluate the association between central venous catheter (CVC) insertion site and microbiological CVC complications in a nationwide cohort. ⋯ Low CRBSI incidence rates were reported. CRBSI incidences rates were similar in the three insertion sites. Uncertainty remains due to potential selection bias since many CVCs had to be excluded.
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Intensive care medicine · Nov 2024
Environmental sustainability in intensive care: the path forward. An ESICM Green Paper.
The European Society of Intensive Care Medicine (ESICM) Green Paper aims to address the challenge of environmental sustainability in intensive care and proposes actionable strategies for integrating sustainability into intensive care unit (ICU) stakeholder actions. ⋯ The ESICM Green Paper reviewed the relevance of climate change to intensive care and provided suggestions for clinical practice, research, education, and ESICM organizational domains. It underscores that reducing intensive care's ecological footprint can coexist with high-quality patient care. Promoting a resilient, responsible healthcare system is a joint responsibility of all ICU stakeholders.
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Intensive care medicine · Nov 2024
Fluid responsiveness in acute respiratory distress syndrome patients: a post hoc analysis of the HEMOPRED study.
Optimal fluid management in patients with acute respiratory distress syndrome (ARDS) is challenging due to risks associated with both circulatory failure and fluid overload. The performance of dynamic indices to predict fluid responsiveness (FR) in ARDS patients is uncertain. ⋯ Performance of dynamic indices to predict FR appears preserved in ARDS patients, albeit with distinct thresholds. Hypovolemia, indicated by a > 32% increase in aortic VTI during PLR, rather than FR, was associated with ICU mortality in this population.
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Intensive care medicine · Nov 2024
From bytes to bedside: a systematic review on the use and readiness of artificial intelligence in the neonatal and pediatric intensive care unit.
Despite its promise to enhance patient outcomes and support clinical decision making, clinical use of artificial intelligence (AI) models at the bedside remains limited. Translation of advancements in AI research into tangible clinical benefits is necessary to improve neonatal and pediatric care for critically ill patients. This systematic review seeks to assess the maturity of AI models in neonatal and pediatric intensive care unit (NICU and PICU) treatment, and their risk of bias and objectives. ⋯ The majority of AI models remain within the testing and prototyping phase and have a high risk of bias. Bridging the gap between designing and clinical implementation of AI models is needed to warrant safe and trustworthy AI models. Specific guidelines and approaches can help improve clinical outcome with usage of AI.