Journal of critical care
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Journal of critical care · Dec 2018
ReviewPerceptions of medical futility in clinical practice - A qualitative systematic review.
To summarize and compare qualitative studies which explored attitudes of patients, families and healthcare providers towards medical futility. ⋯ This review describes existing opinions about medical futility and demonstrates the multifaceted understanding of medical futility by physicians, caregivers and patients. The difficulties in defining medical futility demonstrate the need for resources to help healthcare providers and patients to deal with decision-making in such situations.
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Journal of critical care · Dec 2018
ReviewUrine electrolyte measurement as a "window" into renal microcirculatory stress assessment in critically ill patients.
Urine electrolyte assessment has long been used in order to understand electrolyte concentration disturbances in blood and as an easy tool for monitoring renal perfusion and structural tubular damage. In the last few years, great improvement in the pathophysiology of acute kidney injury (AKI) has occurred, and the correlation between urine biochemistry (UB) behavior and renal perfusion was frequently questioned. ⋯ Our group has been working in this field in the critically ill population, and we believe that, although UB is indeed very useful, a different point of view regarding the interpretation of the data should be used. The aim of this review is to explain the rationale of these new concepts and make suggestions for their adequate use in daily ICU practice, especially in low-income countries where more sophisticated and expensive AKI biomarker assessments are not available.
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Journal of critical care · Dec 2018
ReviewThe effects of team-training in intensive care medicine: A narrative review.
Research into team-training within healthcare is growing exponentially. We aim to evaluate the effects of team-training within intensive care medicine (ICM) through a review of the literature and a narrative synthesis of the results. ⋯ Team-training has been studied in multiple ICU team types, with crew resource management (CRM) and TeamSTEPPS curricula commonly used to support teaching via simulation. Clinical skills taught have included ALS provision, ECMO initiation, advanced airway management, sepsis management and trauma response skills. Team-training in ICU is well received by staff, facilitates clinical learning, and can positively alter staff behaviors. Few clinical outcomes have been demonstrated and the duration of the behavioral effects is unclear.
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Journal of critical care · Dec 2018
ReviewContemporary management of severe influenza disease in the intensive care unit.
Despite continued efforts to optimize vaccination composition, severe influenza disease requiring intensive care unit (ICU) admission remains a clinical issue. Influenza epidemics and pandemics worldwide continue to challenge clinicians with managing infected patients requiring ICU care. While routine use of antiviral therapy is deployed in ambulatory outpatients, their use in the ICU in patients with hypoxemic respiratory failure is less well established. ⋯ These data have given rise to a growing interest in the use of immune modulating therapies for treatment of severe influenza. Additionally, pandemic outbreaks have revealed the growing need for salvage management, wherein lies the potential role for venovenous extracorporeal membrane oxygenation therapy in refractory respiratory failure. In this report, we review the contemporary ICU care of the severe influenza patient.
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Journal of critical care · Dec 2018
Meta AnalysisPrognostic value of plasma brain natriuretic peptide value for patientswith sepsis: A meta-analysis.
The aim of this meta-analysis was to clarify the diagnostic role of plasma BNP and NT-proBNP in predicting mortality for septic patients. ⋯ This meta-analysis indicates that both elevated plasma BNP and NT-proBNP have moderate predicts value for the mortality of septic patients, and the tested method and observation endpoint influence the results of BNP.