Journal of critical care
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Journal of critical care · Dec 2015
Review Meta AnalysisIncreased return of spontaneous circulation at the expense of neurologic outcomes: Is prehospital epinephrine for out-of-hospital cardiac arrest really worth it?
Current guidelines for the management of out-of-hospital cardiac arrest (OHCA) recommend the use of prehospital epinephrine by initial responders. This recommendation was initially based on data from animal models of cardiac arrest and minimal human data, but since its inception, more human data regarding prehospital epinephrine in this setting are now available. Although out-of-hospital return of spontaneous circulation (ROSC) may be higher with the use of epinephrine, worse neurologic outcomes may be associated with its use. ⋯ Use of epinephrine before arrival to the hospital for OHCA does not increase survival to discharge but does make it more likely for those who are discharged to have poor neurologic outcome. There is a need for additional randomized controlled trials.
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Journal of critical care · Dec 2015
Randomized Controlled Trial Multicenter StudyImpact of endotracheal intubation on septic shock outcome: A post hoc analysis of the SEPSISPAM trial.
The objective of the study to is to determine the characteristics associated with endotracheal intubation in septic shock patients. ⋯ Practices regarding the place of endotracheal intubation in septic shock may impact outcome.
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Journal of critical care · Dec 2015
ReviewImportant clinician information needs about family members in the intensive care unit.
Clinicians often lack key information regarding intensive care unit (ICU) families. Our objective was to identify (1) important information for clinicians to know about ICU families when making decisions and (2) important information for families to know about patients from clinicians. ⋯ Through qualitative and quantitative analysis, we identified important information for ICU clinicians to know about family members and for family members to know about patients. The identified information can be used to guide strategies and tools to improve assessment of and communication with families.
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Altered mental status is a common pathological entity in critically ill patients and particularly in those with preexisting cerebral injury. In the neurological critical care unit, the prevalence of altered mental status is especially high because of the inherent nervous system disease of these patients. ⋯ Although often used interchangeably, the 2 pathological entities have subtle differences in etiology and presentation. This is a review of delirium and encephalopathy in the neurological critical care unit.