Critical care medicine
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Critical care medicine · Oct 2012
The impact of meeting donor management goals on the number of organs transplanted per donor: results from the United Network for Organ Sharing Region 5 prospective donor management goals study.
Many organ procurement organizations have implemented critical care end points as donor management goals in efforts to increase organs transplanted per donor after neurologic determination of death. Although retrospective studies have demonstrated an association between meeting donor management goals and organ yield, prospective studies are lacking. ⋯ Meeting donor management goals prior to consent and prior to organ recovery were both associated with achieving ≥4 organs transplanted per donor. However, only 15% of donors have donor management goals met at the time of consent. The donor hospital management of patients with catastrophic brain injuries, before the intent to donate organs is known, affects outcomes and should remain a priority in the intensive care unit.
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Critical care medicine · Oct 2012
Core competency in mechanical ventilation: development of educational objectives using the Delphi technique.
We sought to identify and standardize the core clinical knowledge and skills required to care for patients receiving mechanical ventilation. ⋯ There is a consensus that general resident core competency in mechanical ventilation requires a broad range of knowledge application and skill. These educational objectives may help identify and standardize the educational outcomes related to mechanical ventilation that residents should achieve.
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Critical care medicine · Oct 2012
Quality improvement and cost savings after implementation of the Leapfrog intensive care unit physician staffing standard at a community teaching hospital.
Prior studies have shown that implementation of the Leapfrog intensive care unit physician staffing standard of dedicated intensivists providing 24-hr intensive care unit coverage reduces length of stay and in-hospital mortality. A theoretical model of the cost-effectiveness of intensive care unit physician staffing patterns has also been published, but no study has examined the actual cost vs. cost savings of such a program. ⋯ Implementation of the Leapfrog intensive care unit physician staffing standard significantly reduced intensive care unit length of stay and lowered the prevalence of ventilator-associated pneumonia and central venous access device infection. A cost analysis yielded a 1-yr institutional return on investment of 105%. Our study confirms that implementation of the Leapfrog intensive care unit physician staffing model in the community hospital setting improves quality measures and is economically feasible.
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Critical care medicine · Oct 2012
Mechanical ventilation reduces rat diaphragm blood flow and impairs oxygen delivery and uptake.
Although mechanical ventilation is a life-saving intervention in patients suffering from respiratory failure, prolonged mechanical ventilation is often associated with numerous complications including problematic weaning. In contracting skeletal muscle, inadequate oxygen supply can limit oxidative phosphorylation resulting in muscular fatigue. However, whether prolonged mechanical ventilation results in decreased diaphragmatic blood flow and induces an oxygen supply-demand imbalance in the diaphragm remains unknown. ⋯ These new and important findings reveal that prolonged mechanical ventilation results in a time-dependent decrease in the ability of the diaphragm to augment blood flow to match oxygen demand in response to contractile activity and could be a key contributing factor to difficult weaning. Although additional experiments are required to confirm, it is tempting to speculate that this ventilator-induced decline in diaphragmatic oxygenation could promote a hypoxia-induced generation of reactive oxygen species in diaphragm muscle fibers and contribute to ventilator-induced diaphragmatic atrophy and contractile dysfunction.
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Critical care medicine · Oct 2012
Effect of treatment delay on disease severity and need for resuscitation in porcine fecal peritonitis.
Early treatment in sepsis may improve outcome. The aim of this study was to evaluate how the delay in starting resuscitation influences the severity of sepsis and the treatment needed to achieve hemodynamic stability. ⋯ Increasing the delay between sepsis initiation and resuscitation increases disease severity, need for resuscitation, and sepsis-associated brain mitochondrial dysfunction. Our results support the concept of a critical window of opportunity in sepsis resuscitation.