Journal of critical care
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Journal of critical care · Oct 2019
Observational StudyCentral venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference (PcvaCO2/CavO2) reflects microcirculatory oxygenation alterations in early septic shock.
To explore the relationship between central venous-to-arterial carbon dioxide difference (PcvaCO2), PcvaCO2/arterial-venous oxygen content difference ratio (PcvaCO2/CavO2) and the microcirculatory status, evaluated by using near-infrared spectroscopy, in septic shock patients. ⋯ In a population of early septic shock patients, increases in PcvaCO2 and PcvaCO2/CavO2 reflected different alterations at the microcirculatory level. While PcvaCO2 was related to global flow, the PcvaCO2/CavO2 ratio was associated to impaired local oxygen utilization and diminished microvascular reactivity.
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Journal of critical care · Oct 2019
Multicenter Study Observational StudyWould you like to be admitted to the ICU? The preferences of intensivists and general public according to different outcomes.
Intensivists hold different views on their own thresholds for intensive care admission versus those they hold for patients.
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Journal of critical care · Oct 2019
ReviewClinical controversies in abdominal sepsis. Insights for critical care settings.
Sepsis is a deadly condition in which the outcome is associated with prompt and adequate recognition, intensive supportive care, antibiotic administration and source control. This last item makes abdominal sepsis a unique treatment challenge. Although pneumonia constitutes the leading cause of sepsis, abdominal sepsis has unique features that merit discussion. ⋯ The epidemiology of abdominal sepsis and its outcomes are difficult to assess due to the large clinical heterogeneity associated with this entity. Further complicating issues is the debate surrounding the effect of early source control (i.e. the "surgeon effect"). This review evaluates and summarizes the current approach to current challenges in patient care and which are the future research directions.
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Journal of critical care · Oct 2019
Randomized Controlled Trial Multicenter StudyVariability in triage practices for critically ill cancer patients: A randomized controlled trial.
Intensive care triage practices and end-user interpretation of triage guidelines have rarely been assessed. We evaluated agreement between providers on the prioritization of patients for ICU admission using different triage guidelines. ⋯ The low agreement amongst practitioners on the prioritization of cancer patient cases for ICU admission existed using both general triage guidelines and guidelines tailored only to cancer patients. The lack of consensus on intensive care unit triage practices in the oncological population exposes a potential barrier to appropriate resource allocation that needs to be addressed.
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Journal of critical care · Oct 2019
Multicenter StudyCurrent practice and perceptions regarding pain, agitation and delirium management in patients receiving venovenous extracorporeal membrane oxygenation.
To characterize monitoring of pain, agitation, and delirium; investigate opioid and sedative choices; and describe prevention and treatment of delirium in adults receiving venovenous extracorporeal membrane oxygenation (vv-ECMO) for respiratory failure. ⋯ Most respondents use validated scales and protocols to assess and manage pain, agitation/sedation, and delirium. The majority of respondents reported targeting a deep level of sedation with propofol being used for both deep and light levels of sedation.