Critical care medicine
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Critical care medicine · Mar 2009
ReviewPay for performance in the intensive care unit--opportunity or threat?
Ongoing evidence of poor-quality healthcare has stimulated the development of provider reimbursement schemes linked to the delivery of high-quality care. Our objective was to describe these programs and their potential implementation in intensive care units (ICUs). ⋯ Participation in pay-for-performance programs is a potential opportunity for intensivists and ICU teams to improve outcomes for their patients in partnership with regulatory agencies and healthcare funders. Because many aspects of optimal design of these programs in ICUs are unknown, robust evaluations of their effect on healthcare quality should be integrated into any implementations.
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Critical care medicine · Mar 2009
ReviewTherapeutic hypothermia and controlled normothermia in the intensive care unit: practical considerations, side effects, and cooling methods.
Hypothermia is being used with increasing frequency to prevent or mitigate various types of neurologic injury. In addition, symptomatic fever control is becoming an increasingly accepted goal of therapy in patients with neurocritical illness. However, effectively controlling fever and inducing hypothermia poses special challenges to the intensive care unit team and others involved in the care of critically ill patients. ⋯ Temperature management and hypothermia induction are gaining importance in critical care medicine. Intensive care unit physicians, critical care nurses, and others (emergency physicians, neurologists, and cardiologists) should be familiar with the physiologic effects, current indications, techniques, complications and practical issues of temperature management, and induced hypothermia. In experienced hands the technique is safe and highly effective.
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Critical care medicine · Mar 2009
Comparative StudyUltrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit.
To determine whether ultrasound (US) increases successful central venous catheter (CVC) placement, decreases site attempts, and decreases CVC placement complications. ⋯ US-guided CVC placement in children is associated with decreased number of anatomical sites attempted and decreased number of attempts to gain placement. Time to placement by residents was decreased with US, but not the time to placement by other operators. US guidance increased the use of internal jugular catheter placement and decreased artery punctures. US guidance did not improve success rates.
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Critical care medicine · Mar 2009
Changes in buccal microcirculation following extracorporeal membrane oxygenation in term neonates with severe respiratory failure.
Extracorporeal membrane oxygenation (ECMO) is known to improve cardiorespiratory function and outcome in neonates with severe respiratory failure. In this study, we tested two hypotheses: 1) neonates with severe respiratory failure exhibit alterations of the microcirculation and 2) after ECMO therapy these microcirculatory alterations are improved. ⋯ Microcirculatory parameters are depressed in neonates with severe respiratory failure and improve significantly following ECMO treatment.
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Critical care medicine · Mar 2009
Assessment of venous return curve and mean systemic filling pressure in postoperative cardiac surgery patients.
To measure the relationship between blood flow and central venous pressure (Pcv) and to estimate mean systemic filling pressure (Pmsf), circulatory compliance, and stressed volume in patients in the intensive care unit. ⋯ Pmsf can be determined in intensive care patients with an intact circulation with use of inspiratory pause procedures, making serial measures of circulatory compliance and circulatory stressed volume feasible.