Journal of critical care
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Journal of critical care · Dec 2016
Prevalence and factors associated with the absence of pharmacologic venous thromboembolism prophylaxis: A cross-sectional study of Georgia intensive care units.
The need for venous thromboembolism prophylaxis is well accepted in the intensive care unit (ICU) and supported by a variety of guideline recommendations. Several studies have highlighted poor adherence to these recommendations, but it is unknown why this discrepancy exists. The aim of this study is assess the prevalence of pharmacoprophylaxis and characterize the practice of withholding prophylaxis. ⋯ Venous thromboembolism prophylaxis is commonly omitted in ICU patients, and reasons for omission vary. An elevated international normalized ratio is associated with withholding of pharmacologic prophylaxis.
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Journal of critical care · Dec 2016
Impact of early do-not-attempt-resuscitation orders on procedures and outcomes of severe sepsis.
Do-not-attempt-resuscitation (DNAR) orders are common in severe sepsis, but the impact on clinical care is not known. Our primary objective was to determine the impact of early DNAR orders on in-hospital mortality and performance of key interventional procedures among severe sepsis hospitalizations. Our secondary objective was to further investigate what patient characteristics within the sepsis DNAR population affected outcomes. ⋯ Although DNAR orders are not synonymous with "do not treat," they may unintentionally limit aggressive treatment for severe sepsis patients, especially in older adults.
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Patients and staff may experience adverse effects from exposure to noise.
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Journal of critical care · Dec 2016
Do in-hours or off-hours matter for extubating children in the pediatric intensive care unit?
Several studies have suggested worse outcomes for patients requiring medical care at night or on weekends. However, whether or not children should be extubated only during in-hours has not been studied yet. We sought to compare outcomes and complications of in-hours versus off-hours extubated patients. ⋯ Patients extubated at off-hours had more favorable outcomes with similar complications rate compared with those extubated at in-hours. These results provide no support for delaying extubations until in-hours period. Further studies are required to confirm these findings.
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Journal of critical care · Dec 2016
Information handoff and outcomes of critically ill patients transferred between hospitals.
Patients transferred between hospitals are at high risk of adverse events and mortality. This study aims to identify which components of the transfer handoff process are important predictors of adverse events and mortality. ⋯ Documentation completeness is associated with improved outcomes and resource utilization in patients transferred between hospitals.