Journal of critical care
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Journal of critical care · Dec 2013
Initial fractal exponent of heart rate variability is associated with success of early resuscitation in patients with severe sepsis or septic shock: a prospective cohort study.
Heart rate variability (HRV) reflects autonomic nervous system tone as well as the overall health of the baroreflex system. We hypothesized that loss of complexity in HRV upon intensive care unit (ICU) admission would be associated with unsuccessful early resuscitation of sepsis. ⋯ Loss of complexity in HRV is associated with worse outcome early in severe sepsis and septic shock. Further work should evaluate whether complexity of HRV could guide treatment in sepsis.
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Journal of critical care · Dec 2013
Severe hyperkalemia can be detected immediately by quantitative electrocardiography and clinical history in patients with symptomatic or extreme bradycardia: A retrospective cross-sectional study.
Detecting severe hyperkalemia is challenging. We explored its prevalence in symptomatic or extreme bradycardia and devised a diagnostic rule. ⋯ Severe hyperkalemia is prevalent in symptomatic or extreme bradycardia and detectable by quantitative electrocardiographic parameters and history.
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Journal of critical care · Dec 2013
A novel method of post-pyloric feeding tube placement at bedside.
Post-pyloric feeding tube placement is often difficult, and special equipment or peristalsis agents are used to aid insertion. Although several reports have described blind techniques for post-pyloric feeding-tube placement, no general consensus about method preference has been achieved. ⋯ With a novel technique, from the bedside, without special tools or drugs, we successfully placed post-pyloric feeding tubes. Essential points when inserting the tube are confirmation of the location of the tube tip by palpation of injected air, and to avoid deflection and looping.
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Journal of critical care · Dec 2013
Analysis of the variations between Accreditation Council for Graduate Medical Education requirements for critical care training programs and their effects on the current critical care workforce.
Adult critical care medicine (CCM) is ill prepared for the demands of an aging US population. Sources have acknowledged a severe shortage of intensivists, yet there has been minimal discussion on the lack of critical care training opportunities. Inconsistencies in training options have led to fragmentation of how critical care services are provided to the US adult population. ⋯ Internal medicine offers the greatest pool of candidates to practice full-time CCM, yet there are minimal opportunities for internists wanting to go into straight CCM without also receiving pulmonary training. However, because many PCCM physicians spend a significant amount of time outside critical care, current PCCM training options do not meet the demand for critical care physicians. In this article, we review the barriers to critical care training opportunities and expanding the intensivist workforce and propose reasonable and practical solutions.