Journal of critical care
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Journal of critical care · Mar 2007
Comparative StudyMechanical ventilation of patients hospitalized in medical wards vs the intensive care unit--an observational, comparative study.
In some hospitals, patients are mechanically ventilated on the wards in addition to the intensive care unit (ICU) because of the shortage of ICU beds. ⋯ We conclude that in medical patients requiring mechanical ventilation, there is a higher in-hospital survival rate in ICU-ventilated patients as compared with ventilated patients managed on the medical wards. In addition, ICU provides a better monitoring associated with less endotracheal tube-related complications and more active ventilatory management.
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Journal of critical care · Mar 2007
ReviewHemofiltration in sepsis and systemic inflammatory response syndrome: the role of dosing and timing.
The benefit of hemofiltration (HF) as an adjunctive treatment of sepsis or the systemic inflammatory response syndrome (SIRS) in critically ill patients is a subject of severe debate. Firm conclusions on this subject are hampered by the heterogeneity in study populations and HF treatments, and the lack of adequately sized randomized controlled clinical trials. The aim of this review was to determine the importance of ultrafiltration dose and timing on the physiologic and clinical effects of HF in sepsis and SIRS. In addition, we discuss the issue of filter pore size. ⋯ Human and animal studies suggest that early initiation and high ultrafiltrate volumes are determinants of the beneficial physiologic and clinical effect of HF in sepsis and SIRS. As yet, the evidence in humans is too low to recommend HF as an adjunctive therapy for critically ill patients with sepsis or SIRS. Regarding the many uncertainties about optimal volume (high or very high) and type of membrane, clinical studies should first focus on endpoints as recovery from organ failure and length of treatment before survival studies are started.
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The desire to provide continuous intensivist management for all intensive care unit (ICU) patients in the face of a massive shortfall of available intensivists prompted the introduction of remote ICU care programs in 1999. The past several years have seen a dramatic increase in the number of health systems adopting this care model. ⋯ Health systems have begun to expand the scope of activities of the remote care team, capitalizing on the potential of this new operational and technology platform to leverage scarce personnel and achieve increases in both clinical effectiveness and provider efficiency. This review summarizes the current state of remote ICU care programs in the United States.
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Journal of critical care · Mar 2007
Development of an e-mail database of US intensive care physicians.
Although surveying critical care physicians regarding their behaviors and attitudes may usefully inform clinical, ethical, and policy questions, few resources exist for surveying intensivists electronically. We sought to develop an e-mail database for all intensivists associated with US training programs in critical care medicine (academic intensivists) and to determine the feasibility of using this database to survey intensivists. ⋯ This database provides a unique resource for investigators wishing to efficiently identify the views and practice patterns of US academic intensivists and provides a benchmark response rate of approximately 44% for electronic surveys of intensivists.
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Journal of critical care · Mar 2007
Evidence-based modeling of critical illness: an initial consensus from the Society for Complexity in Acute Illness.
Given the complexity of biological systems, understanding their dynamic behaviors, such as the Acute Inflammatory Response (AIR), requires a formal synthetic process. Dynamic Mathematical Modeling (DMM) represents a suite of methods intended for inclusion within the required synthetic framework. The DMM, however, is a relatively novel approach in the practice of biomedical research. The Society for Complexity in Acute Illness (SCAI) was formed in 2004 from the leading research groups using DMM in the study of acute inflammation. This society believes that it is important to offer guidelines for the design, development, and use of DMM in the setting of AIR research to avoid the "garbage in, garbage out" problem. Accordingly, SCAI identified a need for and carried out a critical appraisal of DMM as currently used in the setting of acute illness. ⋯ We believe that the complexity of biological systems requires that DMM needs to be among the methods used to improve understanding and make progress with attempts to characterize and manipulate the AIR. We believe that this consensus statement will help guide the integration, rational implementation, and standardization of DMM into general biomedical research.