Journal of critical care
-
Journal of critical care · Apr 2019
ReviewVentilator-associated pneumonia: The central role of transcolonization.
Ventilator-associated pneumonia remain frequent and serious diseases since they are associated with considerable crude mortality. Pathophysiology is centered on modifications of regional bacterial flora, especially tracheobronchial tree and oropharyngeal sphere. ⋯ Although modification of bacterial flora has been largely studied, the mechanism which underlays the ability of the implantation, growing and interactions with the local microbiome that leads to the observed transcolonization remains to be more clearly deciphered. The aim of our review is to emphasize the cornerstone importance of the "transcolonization" as a nosological entity playing a central role in ventilator-associated pneumonia.
-
Journal of critical care · Apr 2019
Regional differences in the treatment of refractory vasodilatory shock using Angiotensin II in High Output Shock (ATHOS-3) data.
Despite international guidelines, regional differences in treatment of vasodilatory shock remain. We characterized these differences using data from Angiotensin II in High Output Shock (ATHOS-3) trial. ⋯ Management of vasodilatory shock differs globally with respect to utilization of steroids and vasopressors. This practice heterogeneity may influence shock trials interpretation and patient outcomes, though more definitive evidence would require larger prospective intervention data.
-
Journal of critical care · Apr 2019
ReviewThe state of bereavement support in adult intensive care: A systematic review and narrative synthesis.
Despite advances in medical science, patient death and family bereavement are commonly encountered in adult intensive care units (ICUs). This is the first review to investigate the state of ICU bereavement support globally, and the availability and effectiveness of bereavement support interventions. ⋯ The reviewed evidence was weak, and findings were contextually bound. As such, it is difficult to make recommendations for the most acceptable and effective bereavement support intervention(s). Bereavement support in ICU needs further exploration and clinicians must be adequately trained and supported for the delivery of evidence-informed, culturally competent care.
-
Journal of critical care · Apr 2019
Multicenter StudyFactors associated with mortality in severe community-acquired pneumonia: A multicenter cohort study.
Describe characteristics and outcomes of CAP admitted to public ICUs in Brazil. ⋯ CAP is associated with high mortality in patients admitted to public ICUs in Brazil. The current findings may help improve resource allocation and should aim at improving access to ICU care since delayed admission was associated with increased hospital mortality.
-
Journal of critical care · Apr 2019
ReviewOutcome of invasive mechanical ventilation in cancer patients: Intubate or not to intubate a patient with cancer.
The outcome of cancer patients who undergo mechanical ventilation has been grim. However, it has lately become more promising, creating hesitation when approaching the decision to intubate a cancer patient. Therefore, the main goal was to find some factors that could predict mortality. ⋯ The aforementioned predicting factors could be used when approaching the decision to intubate. When in doubt, we should give the benefit to the patient, proceed to intubate and reevaluate progress daily and in doing so, we would suggest to use the trends in SOFA score and weaning index to assess success or failure of invasive mechanical ventilation.