Journal of critical care
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Journal of critical care · Oct 2022
Time-dependent uncertainty of critical care transitions in very old patients - lessons for time-limited trials.
Prognostication for patients with critical conditions remains challenging, especially for very old individuals. Time-limited trials (TLT) are used to decrease prognostic uncertainty in the individual patient by monitoring the response to treatment over a pre-determined period of time. However, there are substantial difficulties with determining the length of that period. This study presents a probabilistic method to estimate a suitable duration of a TLT based on temporal profiles of uncertainty about critical care and outcome. ⋯ Time-dependent patterns of uncertainty concerning the response to critical care can inform decisions about the duration of TLTs which may last up to a week in very old patients.
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Journal of critical care · Oct 2022
Venoarterial extracorporeal membrane oxygenation flow or dobutamine to improve microcirculation during ECMO for refractory cardiogenic shock.
Venoarterial extracorporeal membrane oxygenation (VA ECMO) effectively supports refractory cardiogenic shock (rCS), and sustains macro- and microcirculations. We investigated the respective impact of increasing VA ECMO flow or dobutamine dose on microcirculation in stabilized VA ECMO-treated patients with rCS. ⋯ When macrocirculation has already been restored in patients with ECMO-supported rCS, increasing dobutamine (above 5 μg/kg/min) or ECMO flow did not further improve microcirculation.
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Journal of critical care · Oct 2022
Association of blood pressure variability with short- and long-term cognitive outcomes in patients with critical illness.
Blood pressure variability (BPV), a modifiable risk factor, can compromise cerebral perfusion in critically ill patients. We studied the association between BPV in the intensive care unit (ICU) and short- and long-term cognitive outcomes. ⋯ BPV was associated with increased likelihood of delirium in the ICU. Delirium, but not BPV, was associated with long-term cognitive decline.
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Journal of critical care · Oct 2022
Clinicians' Views on the use of triggers for specialist palliative care in the ICU: A qualitative secondary analysis.
To understand clinicians' views regarding use of clinical criteria, or triggers, for specialist palliative care consultation in the ICU. ⋯ ICU and palliative care clinicians identified important issues to consider when implementing triggers for specialist palliative care consultation. Future research is needed to longitudinally examine the most appropriate triggers and best practices for trigger implementation.
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Journal of critical care · Oct 2022
Red blood cell distribution width as prognostic factor in sepsis: A new use for a classical parameter.
To evaluate Red blood cell distribution width (RDW) as a sepsis prognostic biomarker. ⋯ RDW is an independent prognostic marker of death in septic patients admitted in the ICU that improves SOFA, LODS, APACHE-II and SAPS-II discrimination ability. This parameter could be incorporated to the prognostic scores as a marker of systemic dysfunction and dysregulated inflammatory response.