Journal of critical care
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Journal of critical care · Jun 2014
Acute bacterial meningitis in the intensive care unit and risk factors for adverse clinical outcomes: Retrospective study.
Bacterial meningitis constitutes a medical emergency. Its burden has driven from childhood to the elderly and the immunocompromised population. However, the admission of patients with bacterial meningitis to the intensive care unit (ICU) has been sparsely approached, as have the prognostic factors associated with an adverse clinical outcome. ⋯ Patients with acute bacterial meningitis admitted to ICU had substantial morbidity and mortality. Those with low GCS or absence of fever have a particularly high risk of an adverse outcome.
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Journal of critical care · Jun 2014
Observational StudyIn-hospital fellow coverage reduces communication errors in the surgical intensive care unit.
Staff coverage strategies of intensive care units (ICUs) impact clinical outcomes. High-intensity staff coverage strategies are associated with lower morbidity and mortality. Accessible clinical expertise, team work, and effective communication have all been attributed to the success of this coverage strategy. We evaluate the impact of in-hospital fellow coverage (IHFC) on improving communication of cardiorespiratory events. ⋯ IHFC reduced communication errors.
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Journal of critical care · Jun 2014
Observational StudyEvaluation of a dosing regimen for continuous vancomycin infusion in critically ill patients: An observational study in intensive care unit patients.
We aimed to evaluate a dosing algorithm for continuous vancomycin administration in intensive care unit patients. ⋯ The evaluated vancomycin dosing regimen for continuous infusion allowed rapid achievement of sufficient vancomycin serum levels. However, we frequently observed supra-therapeutic serum vancomycin concentrations in the first days of vancomycin treatment.
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Journal of critical care · Jun 2014
Randomized Controlled TrialCycling-off modes during pressure support ventilation: Effects on breathing pattern, patient effort, and comfort.
Expiratory asynchrony during pressure support ventilation (PSV) has been recognized as a cause of patient discomfort, increased workload, and impaired weaning process. We evaluated breathing pattern, patient comfort, and patient effort during PSV comparing 2 flow termination criteria: fixed at 5% of peak inspiratory flow vs automatic, real-time, breath-by-breath adjustment within the range of 5% to 55%. ⋯ When compared with a fixed termination criterion, the use of a variable, real-time-adjusted termination criterion improved some indices of patient-ventilator synchrony, producing better breathing pattern, less discomfort, and slightly lower patient effort during PSV.
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Journal of critical care · Jun 2014
Multicenter StudyBarriers and facilitators of thromboprophylaxis for medical-surgical intensive care unit patients: A multicenter survey.
The objective of this study was to identify the self-reported barriers to and facilitators of prescribing low-molecular-weight heparin (LMWH) thromboprophylaxis in the intensive care unit (ICU). ⋯ This multicenter survey found several barriers to use of LMWH including cost, concern about bleeding, and lack of resident knowledge of effectiveness. The diversity of reported facilitators suggests that large scale programs may address generic barriers but also need site-specific interprofessional knowledge translation activities.