Journal of critical care
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Journal of critical care · Oct 2016
Comparative StudyComparison of ultrasound guided brachiocephalic and internal jugular vein cannulation in critically ill children.
To determine whether ultrasound (US)-guided longitudinal in-plane supraclavicular cannulation of the brachiocephalic vein (BCV) improves cannulation success rates compared to transverse out-of-plane internal jugular vein (IJV) cannulation in urgent insertion of temporary central venous catheters (CVC) in critically ill children. ⋯ Ultrasound-guided supraclavicular in-plane BCV cannulation improved first attempt CVC cannulation success rates and reduced puncture attempts and cannulation time compared to US-guided out-of-plane IJV in critically ill children. A large randomized clinical trial is warranted to confirm our results.
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Journal of critical care · Oct 2016
Observational StudyClinical and economic burden of bloodstream infections in critical care patients with central venous catheters.
Bloodstream infections (BSIs) complicate the management of intensive care unit (ICU) patients. We assessed the clinical and economic impact of BSI among patients of a managed care provider group who had a central venous catheter (CVC) placed in the ICU. ⋯ Bloodstream infections after CVC placement in ICU patients are associated with significant increases in costs of care and risk of death during the index hospitalization but no differences in readmissions or costs after discharge.
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Journal of critical care · Oct 2016
Observational StudyRoutine delirium monitoring is independently associated with a reduction of hospital mortality in critically ill surgical patients: A prospective, observational cohort study.
Although delirium monitoring is recommended in international guidelines, there is lacking evidence for improved outcome due to it. We hypothesized that adherence to routine delirium monitoring would improve clinical outcome in adult critically ill patients. ⋯ Our data suggest an improved outcome for mechanically ventilated patients being screened for delirium in clinical routine.
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Journal of critical care · Oct 2016
Causes of moral distress in the intensive care unit: A qualitative study.
The purpose of the study is to examine the causes of moral distress in diverse members of the intensive care unit (ICU) team in both community and tertiary ICUs. ⋯ Causes of moral distress vary among ICU professional groups, but all are amenable to improvement.
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Journal of critical care · Oct 2016
Observational StudyPostoperative acute kidney injury in high-risk patients undergoing major abdominal surgery.
Acute kidney injury (AKI) is a frequent complication in high-risk patients undergoing major surgery and is associated with longer hospital stay, increased risk for nosocomial infection and significantly higher costs. ⋯ Mild AKI is a not rare complication in high-risk patients undergoing major abdominal surgery. Although in almost the totality of cases, the indicators of renal function recovered to preoperative levels, post-operative AKI represents a primary risk factor for a prolonged ICU stay.