Journal of critical care
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Journal of critical care · Mar 2003
Seasonal bed closures in an intensive care unit: a qualitative study.
To describe perceptions of the administrative procedures for seasonal bed closures and their consequences in the intensive care unit (ICU), and to critique this example of health care priority setting for legitimacy and fairness. ⋯ Clinicians and administrators are readily able to identify shortcomings in the seasonal bed closure process in the ICU. These shortcomings should be targeted for improvement so that intensive care health services delivery is legitimate and fair.
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Journal of critical care · Mar 2003
CommentIntensive care nurses' and physicians' experiences with demands for treatment: some implications for clinical practice.
This study was conducted to develop an empiric description of intensive care unit (ICU) physicians' and nurses' (participants) experiences providing life-sustaining treatments at the insistence of family members, treatments that they believed should have been withheld or withdrawn. From this description, steps to minimize or prevent their sources of distress in such situations are suggested. ⋯ Conflict with family members about decisions to limit life-sustaining treatment can be very stressful for health care providers. Three important areas that give rise to distress were identified in this study. These key sources of distress should be looked for. They could be addressed by: (1) identifying to family members the importance of minimizing suffering and ongoing bodily injury of patients at risk for dying, (2) by doing so addressing directly the distress of family members by the provision of emotional support, and when appropriate directed toward helping them accept that the patient is dying, and (3) pursuing efforts to maintain or create a good relationship with family members despite disagreement about the appropriateness of continuing life-sustaining treatment.
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Journal of critical care · Dec 2002
Predictors for mortality after prolonged mechanical ventilation after cardiac surgery in children.
To identify early mortality-associated clinical risk factors preceding, during, and after cardiac surgery in children. ⋯ Younger age and congestive heart failure were the main preoperative predictors of mortality. Multiorgan dysfunction and septic complication were predictive of an increased risk for death after cardiac surgery. These factors should be investigated in greater depth to assist in guiding aggressive therapeutic approaches for combating early signs of organ system dysfunction and infectious complications in these high-risk patients.
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Journal of critical care · Dec 2002
Randomized Controlled Trial Clinical TrialOccurrence of ventilator-associated pneumonia in mechanically ventilated pediatric intensive care patients during stress ulcer prophylaxis with sucralfate, ranitidine, and omeprazole.
The purpose of the study was to evaluate the effects of sucralfate, ranitidine, and omeprazole use on incidence of ventilatory-associated pneumonia (VAP) and mortality in ventilated pediatric critical care patients. ⋯ Our results did not show any difference in the incidence of VAP, macroscopic stress ulcer bleeding, and mortality in the mechanically ventilated PICU patients treated with ranitidine, omeprazole, or sucralfate, or nontreated subjects. None of the treatment regimens increased VAP compared with the nontreated group. Because there is insufficient data about stress ulcer prophylaxis and VAP in the pediatric age group, more studies with larger numbers of patients are needed.