Journal of critical care
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Journal of critical care · Jun 2022
Invasive fungal infections in critically ill COVID-19 patients in a large tertiary university hospital in Israel.
An increasing number of studies have tried to determine the incidence of invasive fungal infections (IFIs) in COVID-19 patients. Challenges in the diagnosis of pulmonary aspergillosis in these patients have led to new definitions of COVID-19-associated pulmonary aspergillosis (CAPA). The aim of this study was to determine the incidence and outcomes of and risk factors for IFIs in critically-ill COVID-19 patients, using the new definitions, in a tertiary center in Israel. ⋯ The low incidence of CAPA in our group of COVID-19 critically-ill patients was consistent with recent reports, underscoring the importance of differentiating between true infection and colonization. Awareness and timely diagnosis of IFIs in COVID-19 critically-ill patients are imperative considering the associated high mortality.
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Journal of critical care · Jun 2022
The course of adrenomedullin and endothelin levels in patients with vasodilatory shock after cardiac surgery compared to patients after uncomplicated elective cardiac surgery.
The aim of this study was to analyse the course of adrenomedullin (ADM) and endothelin-1 (ET-1) levels in patients with vasodilatory shock after cardiac surgery and to explore differences compared to patients after uncomplicated coronary artery bypass graft (CABG) surgery. ADM and ET-1 are involved in the vasomotor response during vasodilatory shock. ⋯ Significantly higher levels of MR-proADM and CT-proET-1 and a different course of both biomarkers were observed in patients with vasodilatory shock after cardiac surgery and seemed to be associated with organ dysfunction.
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Journal of critical care · Jun 2022
Randomized Controlled Trial Multicenter StudySteps to recovery: Body weight-supported treadmill training for critically ill patients: A randomized controlled trial.
Early mobilization of critically ill patients improves functional recovery, but is often hampered by tubes, drains, monitoring devices and muscular weakness. A mobile treadmill with bodyweight support facilitates early mobilization and may shorten recovery time to independent ambulation as compared to usual care physiotherapy alone. ⋯ BWSTT seems a promising intervention to enhance recovery of ambulation and shorten hospital length of stay of ICU patients, justifying a sufficiently powered multicenter RCT.
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Journal of critical care · Jun 2022
Design thinking to improve healthcare delivery in the intensive care unit: Promise, pitfalls, and lessons learned.
Design thinking is a problem-solving approach characterized by the empathetic lens through which designers integrate perspectives of end-users and key stakeholders throughout the entire process of developing solutions. This approach is rooted in diverse fields including engineering, computer science, psychology, and business and is increasingly widespread in healthcare. Herein, we describe the promise of design thinking to help solve intractable problems in healthcare delivery, including those within the complex social and technical intensive care unit system. ⋯ However, given the high stakes of design failure in healthcare, we also discuss the limitations of this approach and the potential consequences of inadequate application. Finally, we suggest a pathway forward that combines the philosophy and tools of design thinking with existing methods within healthcare delivery science, such as qualitative research, quality improvement methods, and implementation science. Ultimately, we argue that design thinking is a valuable approach to guide designers, clinicians, researchers, and administrators towards a more genuine understanding of the healthcare experience, through the lens of patients, their families, and frontline clinicians.