Journal of critical care
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Journal of critical care · Dec 2017
Intermediate care to intensive care triage: A quality improvement project to reduce mortality.
Medical patients whose care needs exceed what is feasible on a general ward, but who do not clearly require critical care, may be admitted to an intermediate care unit (IMCU). Some IMCU patients deteriorate and require medical intensive care unit (MICU) admission. In 2012, staff in the Johns Hopkins IMCU expressed concern that patient acuity and the threshold for MICU admission were too high. Further, shared triage decision-making between residents and supervising physicians did not consistently occur. ⋯ Using a structured quality improvement process targeting triage education and increased resident/supervisor communication, we demonstrated reduced mortality among patients transferred from the IMCU to the MICU.
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Journal of critical care · Dec 2017
Association between timing of intubation and outcome in critically ill patients: A secondary analysis of the ICON audit.
The optimal timing of endotracheal intubation in critically ill patients requiring invasive mechanical ventilation remains undefined. ⋯ In this large cohort of critically ill patients requiring intubation, intubation >2days after admission was associated with increased mortality later in the hospital course.
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Journal of critical care · Dec 2017
Observational StudyClinical and laboratory predictors of Infectious Complications in patients after Out-of-Hospital Cardiac Arrest.
Identification of clinical and laboratory predictors related to Infectious Complications (ICs) in patients after Out-of-Hospital Cardiac Arrest (OHCA). ⋯ Early initiated antibiotic treatment is overused in patients after OHCA. This practice is associated with necessitating antibiotic change in the majority of patients with IC. Assessment of clinical and laboratory parameters in the first days after OHCA increases the likelihood of appropriate ATB therapy.
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Journal of critical care · Dec 2017
Decision support system facilitates rapid decreases in pressure support and appropriate inspiratory muscle workloads in adults with respiratory failure.
A commercially available decision support system (DSS) provides guidance for setting inspiratory pressure support (PS) to maintain work of breathing (WOB/min), breathing frequency (f), and tidal volume (VT) in proper clinical ranges (VentAssist™). If these values are outside the proper clinical range patients may suffer fatigue, atrophy, hypoventilation, hyperventilation, volutrauma, or VT deficiency. The purpose of our study was to evaluate the increase of the percentage of breaths in the targeted clinical ranges when the DSS guidance for setting the PS was followed. ⋯ The DSS is successful at assisting clinicians on how to set PS specific to a patient's individual demands (VT and f) while accounting for their breathing effort (WOB/min). The DSS appears to promote rapid weaning of PS to minimal ventilator settings when appropriate.
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Journal of critical care · Dec 2017
Stroke volume guided resuscitation in severe sepsis and septic shock improves outcomes.
To determine whether stroke volume (SV) guided fluid resuscitation in patients with severe sepsis and septic shock alters Intensive Care Unit (ICU) fluid balance and secondary outcomes, this retrospective cohort study evaluated consecutive patients admitted to an ICU with the primary diagnosis of severe sepsis or septic shock. Cohorts were based on fluid resuscitation guided by changes in SV or by usual care (UC). The SV group comprised 100 patients, with 91 patients in the UC group. ⋯ The SV group was less likely to require acute hemodialysis (6.25%) compared with the UC group (19.5%) (RR, 0.32; p=0.01). In multivariable analysis, SV was an independent predictor of lower fluid balance, LOS, time on vasopressors, and not needing mechanical ventilation. This study demonstrated that SV guided fluid resuscitation in patients with severe sepsis and septic shock was associated with reduced fluid balance and improved secondary outcomes.