Journal of critical care
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Journal of critical care · Apr 2019
Airway pressure release ventilation does not increase intracranial pressure in patients with traumatic brain injury with poor lung compliance.
The use of Airway Pressure Release Ventilation (APRV) in patients with traumatic brain injury (TBI) remains controversial. Some believe that elevated mean airway pressures transmitted to the thorax may cause clinically significant increases in Central Venous Pressure (CVP) and intracranial pressure (ICP) from venous congestion. We perform a retrospective review from 2009 to 2015 of traumatically injured patients who were transitioned from traditional ventilator modes to APRV and also had an ICP monitor in place. ⋯ Individually, only 4 patients had ICP values >20 in the first hour after transitioning to APRV and the rate of ICP elevations was similar between the two modes of ventilation. These data show that APRV is a viable mode of ventilation in patients with TBI who have low lung compliance. The increased CVP of this mode of ventilation did not affect ICP or hemodynamic parameters.
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Journal of critical care · Apr 2019
ReviewDecision-making in ICU - A systematic review of factors considered important by ICU clinician decision makers with regard to ICU triage decisions.
The ICU is a scarce resource within a high-stress, high-stakes, time-sensitive environment where critically ill patients with life-threatening conditions receive expensive life-sustaining care under the guidance of expert qualified personnel. The implications of decisions such as suitability for admission into ICU are potentially dire and difficult. ⋯ The complex and dynamic ICU triage decision is affected by numerous interacting factors. The literature provides some indication of these factors, but fail to show complexities and interactions between them. A decision tree is proposed. Further research should include a reflection on how decisions for admission to ICU are made, such that a better understanding of these processes can be achieved allowing for improved individual and group consistency.
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Journal of critical care · Apr 2019
The impact of psychological distress on long-term recovery perceptions in survivors of cardiac arrest.
To determine the association of depressive and PTSD symptoms with cardiac arrest survivors' long-term recovery perceptions, after accounting for cognitive status, functional independence, and medical comorbidities. ⋯ In contrast with cognitive and functional measures, depressive symptoms were strongly associated with cardiac arrest survivors' negative recovery perceptions at 6-months post-discharge.
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Journal of critical care · Apr 2019
Comparative StudyLacosamide versus phenytoin for the prevention of early post traumatic seizures.
To compare the efficacy and safety of lacosamide versus phenytoin for seizure prophylaxis following TBI. ⋯ There was no difference between lacosamide and phenytoin in the prevention of early post traumatic seizures in patients following TBI. Lacosamide may have a more tolerable side effect profile.
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Journal of critical care · Apr 2019
Postdischarge long-term cardiovascular outcomes of intensive care unit survivors who developed dialysis-requiring acute kidney injury after cardiac surgery.
Dialysis-requiring acute kidney injury (AKI-D) after cardiac surgery is a major cause of in-hospital mortality. However, the long-term outcome has not been previously examined. ⋯ AKI-D following cardiac surgery was associated with worse long-term postdischarge mortality and elevated risks of dialysis dependency and MACE development. The outcomes were consistent even in the patients who recovered from the dialysis.