Journal of critical care
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Journal of critical care · Dec 2013
ReviewInterprofessional care in intensive care settings and the factors that impact it: Results from a scoping review of ethnographic studies.
At the heart of safe cultures are effective interactions within and between interprofessional teams. Critical care clinicians see severely ill patients who require coordinated interprofessional care. In this scoping review, we asked: "What do we know about processes, relationships, organizational and contextual factors that shape the ability of clinicians to deliver interprofessional care in adult ICUs?" Using the 5-stage process established by Levac et al. (2010), we reviewed 981 abstracts to identify ethnographic articles that shed light on interprofessional care in the intensive care unit. ⋯ Overall, studies were of mixed quality, with an average (SD) score of 5.8 out of 10 (1.77). Insights into intensive care unit cultures include the importance of paying attention to workflow, the nefarious impact of hierarchical relationships, the mixed responses to protocols imposed from the top down, and a general undertheorization of sex and race. This review highlights several lessons for safe cultures and argues that more needs to be known about the context of critical care if quality and safety interventions are to succeed.
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Journal of critical care · Dec 2013
ReviewPractical considerations for the dosing and adjustment of continuous renal replacement therapy in the intensive care unit.
Familiarity with the initiation, dosing, adjustment, and termination of continuous renal replacement therapy (CRRT) is a core skill for contemporary intensivists. Guidelines for how to administer CRRT in the intensive care unit are not well documented. ⋯ Management of electrolyte and acid-base derangements commonly encountered with acute renal failure is emphasized. Knowledge regarding the practical aspects of managing CRRT in the intensive care unit is a prerequisite for achieving desired physiological end points.
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Journal of critical care · Dec 2013
Red blood cell transfusion is associated with decreased in-hospital muscle strength among critically ill patients requiring mechanical ventilation.
Red blood cell (RBC) transfusion is linked to poor functional recovery after surgery and trauma. To investigate one potential mechanism, we examined the association between RBC transfusion and muscle strength in a cohort of critically ill patients. ⋯ Red blood cell transfusion was associated with decreased muscle strength in this cohort of critically ill patients after adjusting for illness severity and organ dysfunction. Further studies are needed to validate these results and probe mechanisms.
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Journal of critical care · Dec 2013
Multicenter Study Observational StudyStewart analysis of apparently normal acid-base state in the critically ill.
This study aimed to describe Stewart parameters in critically ill patients with an apparently normal acid-base state and to determine the incidence of mixed metabolic acid-base disorders in these patients. ⋯ Intensive care unit patients with an apparently normal acid-base state have an underlying mixed metabolic acid-base disorder characterized by acidifying effects of a low SIDa (caused by hyperchloremia) and high SIG combined with the alkalinizing effect of hypoalbuminemia.
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Journal of critical care · Dec 2013
Multicenter StudyMortality after in-hospital cardiopulmonary resuscitation: Multicenter analysis in Korea.
The purpose of this study is to evaluate factors associated with the mortality of patients admitted to intensive care units (ICUs) after in-hospital cardiopulmonary resuscitation (CPR) and the impact of a hospital rapid response system (RRS) on patient mortality in Korea. ⋯ Various physiologic and laboratory parameters were associated with the mortality of post-CPR ICU admitted patients, and the presence of an RRS did not reduce mortality of these patients in our study.