Critical care medicine
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Critical care medicine · Nov 2013
ReviewKnowledge Translation Interventions for Critically Ill Patients: A Systematic Review.
We systematically reviewed ICU-based knowledge translation studies to assess the impact of knowledge translation interventions on processes and outcomes of care. ⋯ Knowledge translation interventions in the ICU that include protocols with or without education are associated with the greatest improvements in processes of critical care.
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Critical care medicine · Nov 2013
Multicenter StudyA Greater Analgesia, Sedation, Delirium Order Set Quality Score Is Associated With a Decreased Duration of Mechanical Ventilation in Cardiovascular Surgery Patients.
Protocols and order sets for the delivery of analgesia, sedation, and delirium care of the critically ill, mechanically ventilated patient have been shown to improve outcomes but are not uniform in hospitals across geographic areas. The extent to which greater order set quality is associated with improved patient outcomes is not known. We hypothesized that cardiac surgery patients cared for at hospitals with a greater analgesia, sedation, and delirium order set quality score (more guideline-concordant order sets) would have a shorter average duration of mechanical ventilation. ⋯ Cardiac surgery hospitals with more guideline-adherent analgesia, sedation, and delirium order sets have patients with shorter mean durations of mechanical ventilation than hospitals with lower order set quality scores.
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Critical care medicine · Nov 2013
Effects of Sitting Position and Applied Positive End-Expiratory Pressure on Respiratory Mechanics of Critically Ill Obese Patients Receiving Mechanical Ventilation.
To evaluate the extent to which sitting position and applied positive end-expiratory pressure improve respiratory mechanics of severely obese patients under mechanical ventilation. ⋯ In critically ill obese patients under mechanical ventilation, sitting position constantly and significantly relieved expiratory flow limitation and auto-positive end-expiratory pressure resulting in a dramatic drop in alveolar pressures. Combining sitting position and applied positive end-expiratory pressure provides the best strategy.