Critical care medicine
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Critical care medicine · Nov 2006
Randomized Controlled Trial Multicenter StudyReduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study.
To assess the feasibility and safety of the respiratory infection control (RIC) device, a silver-coated endotracheal tube, and its effect on bacterial burden in the airways. ⋯ In this prospectively planned, preliminary analysis, the RIC device was feasible and well tolerated. Larger studies are needed to determine whether delayed colonization, reduced colonization rate, and decreased bacterial burden will decrease the incidence of ventilator-associated pneumonia.
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Critical care medicine · Nov 2006
Randomized Controlled Trial Comparative StudyPulsed steroid therapy is an effective treatment for intractable hyperemesis gravidarum.
Intractable hyperemesis gravidarum remains a serious cause of morbidity among pregnant women. If not controlled, hyperemesis gravidarum can lead to severe disability, electrolyte and acid base imbalance, and even various organ system dysfunctions. From the successful use of steroids for chemotherapy-induced emesis, corticosteroids might prove useful in hyperemesis gravidarum. The purpose of this study was to compare the efficacy of pulsed hydrocortisone therapy with that of metoclopramide for the management of intractable hyperemesis gravidarum. ⋯ A short course of hydrocortisone is an effective treatment for intractable hyperemesis gravidarum.
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Critical care medicine · Nov 2006
ReviewMeasuring success of interventions to improve the quality of end-of-life care in the intensive care unit.
Because of the severity of illness, the intensive care unit (ICU) is a setting where death is common. Although optimal palliative care should prevent many terminal ICU admissions, the ICU will always remain an important setting for end-of-life care because of the severity of illness of patients in the ICU and because many patients with chronic, life-limiting diseases and their families opt for a trial of intensive care. ⋯ However, as interventions are designed to improve the quality of end-of-life care in the ICU, researchers, clinicians, and quality improvement personnel will need reliable and valid measures to determine whether these interventions do improve the quality of care. In this article, we examine some of the data supporting potential process and outcome measures that could be used to evaluate the success of interventions designed to improve end-of-life care in the ICU.
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Critical care medicine · Nov 2006
Comparative StudySurrogate markers for adverse outcomes in normotensive patients with pulmonary embolism.
Although echocardiography has proven utility in risk stratifying normotensive patients with pulmonary embolism, echocardiography is not always available. ⋯ Normotensive patients with pulmonary embolism have a high rate of severe adverse outcomes during 6-month follow-up. A panel of three widely available tests can be used to risk stratify patients with pulmonary embolism when formal echocardiography is not available.
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Critical care clinicians no longer consider family members as visitors in the intensive care unit. Family-centered care has emerged from the results of qualitative and quantitative studies evaluating the specific needs of families of patients dying in the intensive care unit. In addition, interventional studies have established that intensive and proactive communication empowers family members of dying patients, helping them to share in discussions and decisions, if they so wish. ⋯ Guidelines for organizing these conferences take into account the specific needs of families, including reassurance that the patient's symptoms will be adequately managed; honest clear information about the patient's condition and treatment; a willingness on the part of physicians to listen and respond to family members and to address their emotions; attention to patient preferences; clear explanations about surrogate decision making; and continuous, compassionate, and technically proficient attention to the patient's needs until death occurs. Means of improving end-of-life care have been identified in epidemiologic and interventional studies. End-of-life family conferences constitute the keystone around which excellent end-of-life care can be built.