Critical care medicine
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Critical care medicine · May 2014
Observational StudyEarly Bispectral Index and Sedation Requirements During Therapeutic Hypothermia Predict Neurologic Recovery Following Cardiac Arrest.
To test the hypothesis that low bispectral index scores and low sedative requirements during therapeutic hypothermia predict poor neurologic outcome. ⋯ Bispectral index scores and sedative requirements early in the course of therapeutic hypothermia improve the identification of patients who will not recover from brain anoxia. The ability to accurately predict nonrecovery after cardiac arrest could facilitate discussions with families, reduce patient suffering, and limit use of ICU resources in futile cases.
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Critical care medicine · May 2014
Comparative StudyFeasibility and Economic Impact of Dedicated Hospice Inpatient Units for Terminally Ill ICU Patients.
End-of-life care is frequently provided in the ICU because patients receiving life-sustaining treatments are often unsuitable for transfer to home or community hospices. In-hospital dedicated hospice inpatient units are a novel option. This study was designed to 1) demonstrate the feasibility of ICU to dedicated hospice inpatient unit transfer in critically ill terminal patients; 2) describe the clinical characteristics of those transferred and compare them to similar patients who were not transferred; and 3) assess the operational and economic impact of dedicated hospice inpatient units. ⋯ Dedicated hospice inpatient units are a feasible way to provide care for terminal ICU patients, but barriers including lack of knowledge of the units and provider or family comfort with leaving the ICU remain. Dedicated hospice inpatient units are potentially significant sources of bed days and cost savings for hospitals and the healthcare system overall.
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Critical care medicine · May 2014
Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle.
The debilitating and persistent effects of ICU-acquired delirium and weakness warrant testing of prevention strategies. The purpose of this study was to evaluate the effectiveness and safety of implementing the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle into everyday practice. ⋯ Critically ill patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle spent three more days breathing without assistance, experienced less delirium, and were more likely to be mobilized during their ICU stay than patients treated with usual care.
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Critical care medicine · May 2014
ReviewThe highs and lows of blood pressure: toward meaningful clinical targets in patients with shock.
Measurement of blood pressure is fundamental for the management of patients in shock, yet the physiological basis and meaning of blood pressure measurements are complex and often not well understood. This article is in two parts: part 1 deals with the mechanical and physiological aspects of blood pressure and its measurement and part 2 deals with the role of changes in regional resistances in the determination of tissue perfusion and bedside approaches to management of shock. ⋯ This article discusses the implications of these points and explores factors that need to be taken into account when designing empiric trials to determine appropriate blood pressure targets for patients in shock. Even if well-studied empirically developed guidelines become available, it likely still will be important to individualize patient management and approaches for this are discussed too.
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Critical care medicine · May 2014
Comparison of Severity-of-Illness Scores in Critically Ill Obstetric Patients: A 6-Year Retrospective Cohort.
The purpose of this research was to evaluate the discrimination and calibration of mortality prediction of Simplified Acute Physiology Score 2, Simplified Acute Physiology Score 3, Mortality Probability Model II, and Mortality Probability Model III in peripartum women. ⋯ Simplified Acute Physiology Score 2 and Simplified Acute Physiology Score 3 overestimate mortality in obstetric critical care patients. Mortality Probability Model III was inadequately calibrated. Mortality Probability Model II showed good fit to predict mortality in a developing country setting. Future studies in developed and developing countries are needed to further confirm our findings.