Journal of critical care
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Journal of critical care · Dec 2018
Multicenter StudyAntibiotics has more impact on mortality than other early goal-directed therapy components in patients with sepsis: An instrumental variable analysis.
To estimate the effect of each of the EGDT components, as well as of the antibiotics, on length-of-stay and mortality. ⋯ Among patients entering ER with infection and shock or hypoperfusion criteria, the use of appropriate antibiotics in the first 3 h is the measure that has the greatest impact on survival. In addition, among patients with hyperlactatemia >4 mmol/L, the clearance of >10% of lactate during resuscitation is associated with better outcomes.
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Journal of critical care · Dec 2018
ReviewPerceptions of medical futility in clinical practice - A qualitative systematic review.
To summarize and compare qualitative studies which explored attitudes of patients, families and healthcare providers towards medical futility. ⋯ This review describes existing opinions about medical futility and demonstrates the multifaceted understanding of medical futility by physicians, caregivers and patients. The difficulties in defining medical futility demonstrate the need for resources to help healthcare providers and patients to deal with decision-making in such situations.
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Journal of critical care · Dec 2018
ReviewUrine electrolyte measurement as a "window" into renal microcirculatory stress assessment in critically ill patients.
Urine electrolyte assessment has long been used in order to understand electrolyte concentration disturbances in blood and as an easy tool for monitoring renal perfusion and structural tubular damage. In the last few years, great improvement in the pathophysiology of acute kidney injury (AKI) has occurred, and the correlation between urine biochemistry (UB) behavior and renal perfusion was frequently questioned. ⋯ Our group has been working in this field in the critically ill population, and we believe that, although UB is indeed very useful, a different point of view regarding the interpretation of the data should be used. The aim of this review is to explain the rationale of these new concepts and make suggestions for their adequate use in daily ICU practice, especially in low-income countries where more sophisticated and expensive AKI biomarker assessments are not available.
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Journal of critical care · Dec 2018
Abrupt versus gradual cessation of steroids in patients with septic shock.
To determine if a difference in hemodynamic stability would be identified in patients with abrupt withdrawal of steroids compared to patients who underwent a taper. ⋯ The abrupt withdrawal of steroids in patients with resolving septic shock did not impact hemodynamic stability and offers an opportunity to reduce medication burden and reduce adverse drug reactions.
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Journal of critical care · Dec 2018
ReviewThe effects of team-training in intensive care medicine: A narrative review.
Research into team-training within healthcare is growing exponentially. We aim to evaluate the effects of team-training within intensive care medicine (ICM) through a review of the literature and a narrative synthesis of the results. ⋯ Team-training has been studied in multiple ICU team types, with crew resource management (CRM) and TeamSTEPPS curricula commonly used to support teaching via simulation. Clinical skills taught have included ALS provision, ECMO initiation, advanced airway management, sepsis management and trauma response skills. Team-training in ICU is well received by staff, facilitates clinical learning, and can positively alter staff behaviors. Few clinical outcomes have been demonstrated and the duration of the behavioral effects is unclear.