Journal of critical care
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Journal of critical care · Dec 2020
ReviewPrediction on critically ill patients: The role of "big data".
Accurate outcome prediction in Intensive Care Units (ICUs) would allow for better treatment planning, risk adjustment of study populations, and overall improvements in patient care. In the past, prognostic models have focused on mortality using simple ordinal severity of illness scores which could be tabulated manually by a human. With the improvements in computing power and proliferation of electronic medical records, entirely new approaches have become possible. Here we review the latest advances in outcome prediction, paying close attention to methods which are widely applicable and provide a high-level overview of the challenges the field currently faces.
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Journal of critical care · Dec 2020
Review Comparative StudyThe role of ultrasound in front-of-neck access for cricothyroid membrane identification: A systematic review.
Conventional palpation techniques for cricothyroid membrane (CTM) identification are inaccurate and unreliable. Ultrasound plays a multi-faceted role in airway management, however there is limited literature around its use for CTM identification prior to cricothyrotomies. This review sought to compare ultrasound to palpation in the general population, identify its indications in subjects with ill-defined neck anatomy, and determine its role in defining neck anatomy. ⋯ Ultrasound appears to be superior to palpation for CTM localization especially in those with difficult airway anatomy and objectively defines neck anatomy. Its pre-emptive use should be incorporated during difficult airway management.
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Journal of critical care · Dec 2020
ReviewPatient-ventilator dyssynchronies: Are they all the same? A clinical classification to guide actions.
Patient ventilatory dyssynchrony (PVD) is a mismatch between the respiratory drive of the patient and ventilatory assistance. It is a complex event seen in almost all ventilated patients and at any ventilator mode, with uncertain significance and prognosis. ⋯ In the present review we aimed to summarize some clinical data on PVD, and to propose a clinical classification based on the type of PVD, from potentially innocuous to clearly harmful PVD, which could help clinicians in the decision-making process from adjusting ventilator settings to deeply sedate or paralyze the patient. Clearly, further studies are needed addressing risk factors, physiologic mechanisms and direct consequences of PVD in order to help clinicians to design effective and proven strategies at the bedside.
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Journal of critical care · Dec 2020
Multicenter StudyHospital outcomes associated with new-onset atrial fibrillation during ICU admission: A multicentre competing risks analysis.
New onset atrial fibrillation (NOAF) in critically ill patients has been associated with increased short-term mortality. Analyses that do not take into account the time-varying nature of NOAF can underestimate its association with hospital outcomes. We investigated the prognostic association of NOAF with hospital outcomes using competing risks methods. ⋯ Using robust methods we demonstrate a stronger prognostic association between NOAF and hospital outcomes than previously reported.