Journal of critical care
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Journal of critical care · Aug 2015
Implementing and sustaining an early rehabilitation program in a medical intensive care unit: A qualitative analysis.
Early rehabilitation programs in a medical intensive care unit can improve patient outcomes, but clinicians face barriers in implementing and sustaining such programs. We sought to describe a multidisciplinary team perspective regarding how to implement and sustain a successful early rehabilitation program. ⋯ This qualitative study of a successful early rehabilitation program highlights the importance of assessing and engaging a multidisciplinary team before implementation and the positive outcomes of early rehabilitation on staff by improving job satisfaction and changing the culture of a hospital unit.
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Journal of critical care · Aug 2015
Review Meta AnalysisAssociations of fluid overload with mortality and kidney recovery in patients with acute kidney injury: A systematic review and meta-analysis.
Fluid resuscitation is commonly administered to maintain adequate renal perfusion in critically ill patients to prevent or even treat acute kidney injury (AKI). However, recent studies show that fluid overload is common and might be associated with poor outcomes in patients with AKI. Hence, the objective of this study was to assess the associations of fluid overload with mortality and kidney recovery in patients with AKI. ⋯ Fluid overload is associated with an increased risk of mortality in patients with AKI. The evidence of the relationship between fluid overload and kidney recovery is insufficient.
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Journal of critical care · Aug 2015
Barriers and supportive conditions to improve quality of care for critically ill patients: A team approach to quality improvement.
Despite the fact that Quality Improvement (QI) teams are widespread tools for improving performance in medical settings, little is known about what makes teams effective and successful. The goal of this study was to identify barriers and supportive conditions for QI teams to implement an effective and successful QI project to improve quality of care. ⋯ Using a grounded theory-based qualitative approach, we identified a framework of conditions supportive of QI-related change, which can help project initiators to create environments that are supportive of change.
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Journal of critical care · Aug 2015
ReviewNormal saline instillation before endotracheal suctioning: "What does the evidence say? What do the nurses think?": Multimethod study.
This study aimed to systematically review studies that investigated the effects of normal saline instillation before endotracheal suctioning and to determine the views of nurses concerning this procedure. ⋯ Although the effects of normal saline instillation on hemodynamics and pneumonia incidence remain controversial, this procedure significantly decreases the oxygenation. Therefore, the use of this procedure is not recommended. However, normal saline instillation is used frequently by nurses to manage thick and tenacious secretions in clinical practice. Additional studies are needed to determine the effectiveness of applications that may be alternatives to normal saline instillation in the management of these secretions.
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Journal of critical care · Aug 2015
Review Case ReportsApnea testing on extracorporeal membrane oxygenation: Case report and literature review.
Extracorporeal membrane oxygenation (ECMO) is used to resuscitate patients with cardiovascular collapse or refractory respiratory failure. Determination of death by neurologic criteria requires the performance of an apnea test. Few data exist describing performance of an apnea test in this setting. Understanding of ECMO physiology and mechanics is critical in the efficient and proper delivery of apnea testing. ⋯ According to current guidelines, apnea testing has to be performed after prerequisites have been met and in a fashion where hypercapnia is achieved in the face of stable oxygenation and hemodynamics. Performance of the test during ECMO is feasible.