Journal of critical care
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Journal of critical care · Apr 2014
ReviewSixty-four-slice computed tomographic scanner to clear traumatic cervical spine injury: Systematic review of the literature.
Cervical spine (CS) injury in blunt trauma is a prevalent and devastating complication. Clearing CS injuries in obtunded patients is fraught with challenges, and no single imaging modality or algorithm is both safe and effective. Increased time in c-spine precautions is associated with greater patient morbidity including increased ventilator associated pneumonia, delirium and ulceration. We systemically reviewed the literature to assess the effectiveness of 64-slice computed tomographic (CT) scanners in clearing traumatic CS injuries. ⋯ Data suggests that using 64-slice CT scans on obtunded trauma patients with grossly intact motor function, in the context of a defined clearance protocol with interpretation by an experienced radiologist, may be sufficient to safely clear significant CS injury. A prospective study comparing MRI and 64-slice CT scan clearance in this population is necessary to corroborate these conclusions.
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Journal of critical care · Apr 2014
Characterizing critical care physician staffing in rural America: A description of Iowa intensive care unit staffing.
This study aimed to characterize intensive care unit (ICU) physician staffing patterns in a predominantly rural state. ⋯ Many Iowa hospitals have ICUs, and staffing patterns in Iowa ICUs mirror closely national staffing practices. Most ICUs are multispecialty, open ICUs in community hospitals. These factors should inform training and resource allocation for intensivists in rural states.
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Journal of critical care · Apr 2014
ReviewA systematic review of goal directed fluid therapy: Rating of evidence for goals and monitoring methods.
To review the literature on goal directed fluid therapy and evaluate the quality of evidence for each combination of goal and monitoring method. ⋯ This review has highlighted the plethora of goals and methods for monitoring fluid therapy. Strikingly, there is scant high quality evidence, in particular for non-invasive G/M combinations in non-operative and non-intensive care settings. There is an urgent need to address this research gap, which will be helped by methodologies to compare utility of G/M combinations.
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Journal of critical care · Apr 2014
Comparative StudyComparison of circuit patency and exchange rates between 2 different continuous renal replacement therapy machines.
Continuous renal replacement therapy (CRRT) is an important tool in the care of critically ill patients. However, the impact of a specific CRRT machine type on the successful delivery of CRRT is unclear. The purpose of this study was to evaluate the effectiveness of CRRT delivery with an intensive care unit (ICU) bedside nurse delivery model for CRRT while comparing circuit patency and circuit exchange rates in 2 Food and Drug Administration-approved CRRT devices. This article presents the data comparing circuit exchange rates for 2 different CRRT machines. ⋯ There was no demonstrable difference in circuit patency as defined by the rate of filter exchanges per day of CRRT therapy.
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Journal of critical care · Apr 2014
Severe acidosis does not predict fatal outcomes in intensive care unit patients: A retrospective analysis.
Severe acidosis is a potentially life-threatening acid-base imbalance. The outcome of patients with severe acidosis has only been anecdotally described. We therefore assessed the discharge rate of such patients from the intensive care unit (ICU) and survival time after the event. ⋯ A significant number of patients can outlast severe acidosis and return to their prehospitalization status. Larger studies are needed to define the patient population most likely to benefit from aggressive resuscitation efforts during severe acidosis.