Journal of critical care
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Journal of critical care · Feb 2017
Review Randomized Controlled TrialOccupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial.
Delirium has negative consequences such as increased mortality, hospital expenses and decreased cognitive and functional status. This research aims to determine the impact of occupational therapy intervention in duration, incidence and severity of delirium in elderly patients in the intensive care unit; secondary outcome was to assess functionality at hospital discharge. ⋯ Occupational therapy is effective in decreasing duration and incidence of delirium in nonventilated elderly patients in the intensive care unit and improved functionality at discharge.
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Journal of critical care · Feb 2017
Meta AnalysisImproved rule-out diagnostic gain with a combined aortic dissection detection risk score and D-dimer Bayesian decision support scheme.
The objective of this study was to develop a Bayesian clinical decision support mathematical model that can assist in assessing a diagnostic utility integrating the aortic dissection detection risk score (ADD-RS) combined with the diagnostic quality of D-dimer testing.
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Journal of critical care · Feb 2017
Randomized Controlled TrialSleep in intensive care unit: The role of environment.
To determine if improving intensive care unit (ICU) environment would enhance sleep quality, assessed by polysomnography (PSG), in critically ill mechanically ventilated patients. ⋯ Characteristics of normal sleep were absent in many of the PSG recordings in these critically ill patients. We were not able to further reduce the already existing low noise levels in the ICU and did not find any association between the environmental intervention and the presence of normal sleep characteristics in the PSG.
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Journal of critical care · Feb 2017
Review Historical ArticleCorticosteroids and neuromuscular blockers in development of critical illness neuromuscular abnormalities: A historical review.
Weakness is common in critically ill patients, associated with prolonged mechanical ventilation and increased mortality. Corticosteroids and neuromuscular blockade (NMB) administration have been implicated as etiologies of acquired weakness in the intensive care unit. Medical literature since the 1970s is replete with case reports and small case series of patients with weakness after receiving high-dose corticosteroids, prolonged NMB, or both. ⋯ This may reflect changes in clinical practice, such as a reduction in steroid dosing, use of cisatracurium besylate instead of aminosteroid NMBs, improved glycemic control, or trends in minimizing mechanical ventilatory support. Thus, based on the most recent and high-quality literature, neither corticosteroids in commonly used doses nor NMB is associated with increased duration of mechanical ventilation, the greatest morbidity of weakness. Minimizing ventilator support as soon as the patient's condition allows may be associated with a reduction in weakness-related morbidity.
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Journal of critical care · Feb 2017
Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock.
Lactate reduction, a common method of risk stratification, has been variably defined. Among patients with an initial lactate >4mmol/L, we compared mortality prediction between a subsequent lactate ≥4mmol/L to a <10% and <20% decrease between initial and subsequent lactate values. ⋯ A subsequent lactate ≥4mmol/L and lactate reduction <20% were associated with increased in-hospital mortality, whereas a lactate reduction <10% was not. Sensitivity and specificity are different between these parameters.