Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Multicenter Study
A multicentre investigation of organ and tissue donation education for critical care residents.
To describe critical care medicine residents' training, expertise, and skills regarding organ and tissue donation processes and procedures. ⋯ Qualitative data corroborated that residents need more exposure to clinical cases, especially regarding DCD donors. A standardized education curriculum would be beneficial for all residents within the ICU. Developing a better shared understanding of the donation process will improve team communication and performance, translate into a better end-of-life experience for families, and potentially result in increased donation rates.
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Multicenter Study Observational Study
Hamilton-DONATE: a city-wide pilot observational study of the ICU management of deceased organ donors.
Improving the medical care of deceased organ donors to increase transplant rates and improve allograft function requires an understanding of the current epidemiology and clinical practices of deceased donation within intensive care units (ICUs). Herein, we report the results of our investigation into the feasibility of a multicentre prospective cohort study addressing the afformentioned issues. ⋯ The Hamilton-DONATE pilot study supports the feasibility of a larger cohort study to describe the epidemiology and clinical practices related to deceased donor care in Canada.
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The intensity of care provided to critically ill patients has been shown to be associated with mortality. In patients with traumatic brain injury (TBI), specialized neurocritical care is often required, but whether it affects clinically significant outcomes is unknown. We aimed to determine the association of the intensity of care on mortality and the incidence of withdrawal of life-sustaining therapies in critically ill patients with severe TBI. ⋯ In general, more intense care was associated with fewer deaths and a lower incidence of withdrawal of life-sustaining therapies in critically ill patients with severe TBI.
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Randomized Controlled Trial Multicenter Study Comparative Study
A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women.
Hypotension is common after spinal anesthesia for Cesarean delivery. It is associated with nausea, vomiting, and fetal acidosis. Previous research on phenylephrine excluded obese subjects. We compared the incidence of intraoperative nausea and vomiting (IONV) in obese patients who received a prophylactic phenylephrine infusion vs those who received bolus dosing for the treatment of spinal-induced hypotension. ⋯ In obese women undergoing Cesarean delivery with spinal anesthesia, prophylactic phenylephrine infusion was associated with less intraoperative nausea, less need for rescue antiemetics, and reduced early postoperative vomiting.
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Multicenter Study
Predictors of intraoperative testing in adults undergoing noncardiac surgery within a regional hospital system.
The use of intraoperative testing is central to anesthesia practice, and point-of-care testing (POCT) is often used. Nevertheless, POCT is costly and its contribution to patient outcome is unknown. There is a lack of guidelines to describe which patients should undergo intraoperative testing or how results should be applied. As such, we undertook a historical cohort study evaluating intraoperative testing practices within our region where POCT is not used. ⋯ Intraoperative testing is common and more likely in patients undergoing high-risk surgical procedures. In a central laboratory system, there is substantial time from ordering the tests to receiving the results. The clinical impact of this delay is unknown. Further evaluation is required regarding the relationship between the time required for intraoperative test results and perioperative outcomes.