Journal of critical care
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Journal of critical care · Apr 2011
Risk factors for prolonged intensive care unit stay and hospital mortality in acute drug-poisoned patients: an evaluation of the physiologic and laboratory parameters on admission.
The share of patients receiving intensive care treatment because of acute drug poisoning is 2% to 14% of all patients receiving intensive care. The outcome is mainly good and the length of intensive care is usually less than 2 days. Our aim was to recognize the risks for prolonged intensive care and hospital mortality using admission Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scoring in acute drug-poisoned patients. ⋯ In acute intoxication, respiratory and renal dysfunction and failure are risk factors for poor outcome.
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Human errors are the most common reason for planes to crash, and of all human errors, suboptimal communication is the number 1 issue. Mounting evidence suggests the same for errors during short-term medical care. Strong verbal communication skills are key whether for establishing a shared mental model, coordinating tasks, centralizing the flow of information, or stabilizing emotions. ⋯ Therefore, this article offers practical strategies borrowed from aviation and applied to critical care medicine. These crisis communication strategies include "flying by voice," the need to combat "mitigating language," the uses of "graded assertiveness" and "5-step advocacy," and the potential role of Situation, Background, Assessment, and Recommendation communication. We also outline the "step-back method," the concept of communication "below ten thousand feet," the impetus behind "closed-loop communication," and the closely related "repeat-back method." The goal is for critical care practitioners to develop a "verbal dexterity" to match their procedural dexterity and factual expertise.
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Journal of critical care · Apr 2011
Editorial CommentLung protective strategy: many pieces of the puzzle.
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Journal of critical care · Apr 2011
Toward less sedation in the intensive care unit: a prospective observational study.
Excessive sedation is associated with prolonged mechanical ventilation and longer intensive care unit (ICU) and hospital stays. We evaluated the feasibility of using minimal sedation in the ICU. ⋯ In a mixed medical-surgical ICU, minimal use of continuous sedation seems feasible without apparent adverse effects.
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Journal of critical care · Apr 2011
Intraoperative adherence to a low tidal volume ventilation strategy in critically ill patients with preexisting acute lung injury.
Low tidal volume (LTV) ventilation reduces mortality in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). This study investigates adherence of intraoperative LTV and whether patient outcomes were different with or without continued intraoperative LTV ventilation in patients with previously established ALI or ARDS. ⋯ Adherence to intraoperative LTV in surgical patients was low. Adherence of LTV intraoperatively was not associated with improved oxygenation, reductions in hospital length of stay, or in-hospital mortality. The importance of adhering to an intraoperative LTV strategy remains unclear.