Journal of critical care
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Journal of critical care · Sep 2009
Multicenter StudyEvaluations of physiologic reactivity and reflexive behaviors during noxious procedures in sedated critically ill patients.
Sedated patients' responses to noxious stimulation are not well characterized. A standardized measure of nociception for use in the intensive care unit (ICU) is elusive. The study aimed to describe cardiovascular and pupil reactivity and behavioral responses between noxious and nonnoxious procedures in sedated ICU patients. ⋯ Certain physiologic reactions and pupil size changes may be potentially useful nociceptive indicators in ICU settings. Further research is needed to determine the clinical parameters of physiologic response change and to evaluate the effects of opioids and sedatives on these physiologic responses.
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Journal of critical care · Dec 2008
Multicenter StudySerial measurements of f/VT can predict extubation failure in patients with f/VT < or = 105?
To evaluate is serial measurements of respiratory rate (frequency to tidal volume, f/VT) may predict extubation failure (EF) from mechanical ventilation in patients following a successful spontaneous breathing trial (SBT) with first measurement of f/V(T) < or = 105. ⋯ Serial f/V(T) measurements during 120 minutes of SBT were unable to detect EF in patients following a successful SBT with initial f/V(T) lower than 105.
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Journal of critical care · Sep 2008
Multicenter StudyThe role of HIV infection and drug and alcohol dependence in hospital mortality among critically ill patients.
Critical care outcomes among HIV-infected patients have improved because of advances in HIV therapy and general improvements in intensive care unit (ICU) management. There is a high co-occurrence of drug and alcohol dependence among HIV-infected patients, and the independent role of drug and alcohol dependence among patients with and without HIV infection in outcomes of critical illness is unclear. ⋯ Although HIV infection is associated with increased hospital mortality, drug and alcohol dependence is not associated with an increased hospital mortality independent of HIV infection.
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Journal of critical care · Sep 2008
Multicenter StudyFactors predicting adherence to the Canadian Clinical Practice Guidelines for nutrition support in mechanically ventilated, critically ill adult patients.
The aim of this study was to determine factors that are associated with adherence to the Canadian nutrition support clinical practice guidelines (CPGs). ⋯ Specific hospital, ICU, and patient characteristics influence adherence to the Canadian nutrition support CPGs. Further research is required to illuminate the mechanisms by which female and surgical patients and community hospitals lead to lower guideline adherence.
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Journal of critical care · Jun 2008
Multicenter StudyImproving patient safety in intensive care units in Michigan.
The aim of this study was to describe the design and lessons learned from implementing a large-scale patient safety collaborative and the impact of an intervention on teamwork climate in intensive care units (ICUs) across the state of Michigan. ⋯ This study describes the first statewide effort to improve patient safety in ICUs. The use of the comprehensive unit-based safety program was associated with significant improvements in safety culture. This collaborative may serve as a model to implement feasible and methodologically rigorous methods to improve and sustain patient safety on a larger scale.