Journal of critical care
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Journal of critical care · Feb 2017
Predicting the need for nonstandard tracheostomy tubes in critically ill patients.
Few guidelines exist regarding the selection of a particular type or size of tracheostomy tube. Although nonstandard tubes can be placed over the percutaneous kit dilator, clinicians often place standard tracheostomy tubes and change to nonstandard tubes only after problems arise. This practice risks early tracheostomy tube change, possible bleeding, or loss of the airway. We sought to identify predictors of nonstandard tracheostomy tubes. ⋯ The findings suggest that clinicians should consider using nonstandard tracheostomy tubes as the first choice if the patient is male with an endotracheal tube size ≥8.0 and has a trachea-to-skin distance >4.4 cm on the computed tomography scan.
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Journal of critical care · Feb 2017
Meta AnalysisThe effect of vasoactive drugs on mortality in patients with severe sepsis and septic shock. A network meta-analysis of randomized trials.
Inotropes and vasopressors are cornerstone of therapy in septic shock, but search for the best agent is ongoing. We aimed to determine which vasoactive drug is associated with the best survival. ⋯ Among several regimens for pharmacological cardiovascular support in septic patients, regimens based on inodilators have the highest probability of improve survival.
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Journal of critical care · Feb 2017
ReviewWhat is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine.
Since their widespread introduction more than half a century ago, intensive care units (ICUs) have become an integral part of the health care system. Although most ICUs are found in high-income countries, they are increasingly a feature of health care systems in low- and middle-income countries. The World Federation of Societies of Intensive and Critical Care Medicine convened a task force whose objective was to answer the question "What is an ICU?" in an internationally meaningful manner and to develop a system for stratifying ICUs on the basis of the intensity of the care they provide. ⋯ A level 1 ICU is capable of providing oxygen, noninvasive monitoring, and more intensive nursing care than on a ward, whereas a level 2 ICU can provide invasive monitoring and basic life support for a short period. A level 3 ICU provides a full spectrum of monitoring and life support technologies, serves as a regional resource for the care of critically ill patients, and may play an active role in developing the specialty of intensive care through research and education. A formal definition and descriptive framework for ICUs can inform health care decision-makers in planning and measuring capacity and provide clinicians and patients with a benchmark to evaluate the level of resources available for clinical care.
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Journal of critical care · Feb 2017
Statistical models for fever forecasting based on advanced body temperature monitoring.
Body temperature monitoring provides health carers with key clinical information about the physiological status of patients. Temperature readings are taken periodically to detect febrile episodes and consequently implement the appropriate medical countermeasures. However, fever is often difficult to assess at early stages, or remains undetected until the next reading, probably a few hours later. ⋯ Both of them exhibited a fever peak forecasting accuracy greater than 84%. When compared with experts' assessment, both models identified 35 (97.2%) of 36 fever spikes. The models proposed are highly accurate in forecasting the appearance of fever spikes within a short period in patients with suspected or confirmed febrile-related illnesses.
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Journal of critical care · Feb 2017
Review Meta AnalysisRole of statins in delirium prevention in critical ill and cardiac surgery patients: A systematic review and meta-analysis.
The data evaluating the role of statins in delirium prevention in the intensive care unit are conflicting and limited. ⋯ In critically ill and cardiac surgery patients, this meta-analysis did not show a benefit with statin therapy in the prevention of delirium.