Journal of critical care
-
Journal of critical care · Dec 2003
Multicenter Study Comparative StudyPrevention of venous thromboembolism in critically ill medical patients: a Franco-Canadian cross-sectional study.
Medical intensive care unit (ICU) patients are at moderate risk of venous thromboembolism (VTE) and prophylaxis against VTE is recommended. ⋯ In this binational cross-sectional observational study of medical ICU patients, we found that 92% of eligible patients received either UFH or LWMH for VTE prophylaxis. Differences in prescribing between countries include significantly greater use of LMWH in France, but use of lower doses than in Canada, and greater use of mechanical VTE prophylaxis in Canada. More randomized trials of VTE prophylaxis in critically ill medical patients would better inform practice.
-
Journal of critical care · Sep 2003
Multicenter StudyInfluence of perceived functional and employment status on cardiopulmonary resuscitation directives.
Perceptions about functional and employment status before admission to the intensive care unit (ICU) may influence how patients and clinicians make decisions about cardiopulmonary resuscitation. ⋯ Functional status impairment perceived by the ICU team is associated clearly with do-not-resuscitate directives in patients unable to participate in decision making. However, the association appears much weaker in patients able to participate in decision making. PATIENTS' perceived employment status also may influence resuscitation decisions. Our results emphasize the challenges of ensuring that crucial resuscitation decisions are not affected adversely by patients' inability to participate in decisions, and by their functional and employment status.
-
Journal of critical care · Sep 2002
Multicenter StudyPrevention of ventilator-associated pneumonia: current practice in Canadian intensive care units.
To evaluate the current use of strategies to prevent ventilator-associated pneumonia (VAP) and to identify interventions to target for quality-improvement initiatives. ⋯ Significant opportunities exist to improve VAP prevention practices in Canada. These strategies include decreasing the frequency of ventilator circuit changes, and increasing the use of non-invasive ventilation, subglottic secretion drainage endotracheal tubes, kinetic bed therapy, small bowel feedings, and elevation of the head of the bed.
-
Journal of critical care · Sep 2002
Multicenter StudySystemic candidiasis in intensive care units: a multicenter, matched-cohort study.
To determine the impact of systemic candidiasis on the mortality and length of hospital stay of intensive care unit (ICU) patients and the associated workload. ⋯ Systemic Candida infections increased mortality and morbidity in severely ill patients. Optimizing management of such infections is imperative.
-
Journal of critical care · Sep 2002
Multicenter StudyStudying communication about end-of-life care during the ICU family conference: development of a framework.
Family-clinician communication in the intensive care unit (ICU) about withholding and withdrawing life support occurs frequently, yet few data exist to guide clinicians in its conduct. The purpose of this study was to develop an understanding of the way this communication is currently conducted. ⋯ This article describes a qualitative methodology to understand clinician-family communication during the ICU family conference concerning end-of-life care and provides a frame of reference that may help guide clinicians who conduct these conferences. We also identify strategies clinicians use to improve communication and enhance the support provided. Further analyses and studies are needed to identify whether this framework or these strategies can improve family understanding or satisfaction or improve the quality care in the ICU.