Journal of critical care
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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.
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Journal of critical care · Oct 2019
Adhering to the procalcitonin algorithm allows antibiotic therapy to be shortened in patients with ventilator-associated pneumonia.
Ventilator-associated pneumonia (VAP) increases exposure to antibiotics. Physicians are however reluctant to shorten treatment, arguing this could lead to failures and worse outcome. Monitoring procalcitonin (PCT) has proven effective for decreasing exposure to antibiotics in randomized controlled trials, but additional "real-life" studies are needed. ⋯ PCT-guided ABT adherence appears safe for patients with VAP and is likely to reduce exposure to antibiotics.
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Journal of critical care · Oct 2019
ReviewEfficacy of music on sedation, analgesia and delirium in critically ill patients. A systematic review of randomized controlled trials.
There is inadequate evidence supporting the benefit of music on sedation, analgesia or delirium in critically ill patients.
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Journal of critical care · Oct 2019
Multicenter StudyQuality of life assessment following amputation for septic shock: a long-term descriptive survey after symmetric peripheral gangrene.
To assess health-related quality of life (HRQOL) following rehabilitation of amputees suffering symmetric peripheral gangrene (SPG) after septic shock. ⋯ ICU survivors referred to rehabilitation centers after SPG-related amputations had impaired HRQOL. At the time of HRQOL assessment, they considered themselves in good health and preferred to be treated again despite disability. Appraisal of long-term functional outcome should not be used to guide end-of-life decision-making in this situation.
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Journal of critical care · Oct 2019
Multicenter Study Observational StudyImpact of timing to source control in patients with septic shock: A prospective multi-center observational study.
Current guidelines recommend that rapid source control should be adopted in patients not >6-12 h after sepsis is diagnosed. However, evidence level of this guideline is not specified, and there is no previous study on patients with septic shock visiting the emergency department (ED). Therefore, we aimed to assess the impact of rapid source control in patients with septic shock visiting the ED. ⋯ Patients with septic shock visiting the ED who underwent source control showed better outcomes than those who did not. We failed to demonstrate the performance of rapid source control reduced the 28-day mortality in septic shock patients. Further studies are required to determine the impact of rapid source control in sepsis and septic shock.