Critical care medicine
-
Critical care medicine · Aug 2016
ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research.
To update the Society of Critical Care Medicine's guidelines for ICU admission, discharge, and triage, providing a framework for clinical practice, the development of institutional policies, and further research. ⋯ Although these are administrative guidelines, the subjects addressed encompass complex ethical and medico-legal aspects of patient care that affect daily clinical practice. A limited amount of high-quality evidence made it difficult to answer all the questions asked related to ICU admission, discharge, and triage. Despite these limitations, the members of the Task Force believe that these recommendations provide a comprehensive framework to guide practitioners in making informed decisions during the admission, discharge, and triage process as well as in resolving issues of nonbeneficial treatment and rationing. We need to further develop preventive strategies to reduce the burden of critical illness, educate our noncritical care colleagues about these interventions, and improve our outreach, developing early identification and intervention systems.
-
Critical care medicine · Aug 2016
Multicenter StudyAssociation Between Resilience and Family Member Psychologic Symptoms in Critical Illness.
There are increased rates of depression, anxiety, and stress disorders in families of critically ill patients. Interventions directed at family members may help their ability to cope with this stress. Specifically, resilience is a teachable psychologic construct describing a person's ability to adapt to traumatic situations. Resilience can inherently assist individuals to diminish adverse psychologic outcomes. Consequently, we determined the relationship between resilience and symptoms of depression, anxiety, and acute stress in family members of critically ill patients. ⋯ When caring for the critically ill, resilient family members have fewer symptoms of depression, anxiety, and acute stress. Resilient families were generally better satisfied with the care delivered. These data suggest that interventions aimed at increasing resilience may improve a family member's experience in the ICU.
-
Critical care medicine · Aug 2016
ReviewCurriculum Development and Evaluation of a Hemodynamic Critical Care Ultrasound: A Systematic Review of the Literature.
The application of ultrasound to assess a patient's cardiac function and volume status is becoming commonplace in the practice of critical care. These skills have been taught through varying curricula; however, no consensus on the optimal curriculum has been established. The purpose of this systematic review is to evaluate the literature regarding critical care ultrasound curriculum development and evaluation. ⋯ Assessment of cardiac function and volume assessment is becoming an essential skill in critical care medicine. Physicians can be taught bedside echocardiography in a time-effective manner with positive benefit to patients by applying a concise curriculum with limited content.
-
Critical care medicine · Aug 2016
ReviewUnpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU.
Patients with a chronic alcohol use disorder presenting to the ICU may be deficient in important vitamins and electrolytes and are often prescribed a "banana bag" as a reflexive standard of therapy. The difficulty of diagnosing Wernicke's encephalopathy in the critical care setting is reviewed. Furthermore, whether the contents and doses of micronutrients and electrolytes in standard banana bags meet the needs of critically ill patients with an alcohol use disorder is assessed based on available evidence. ⋯ Based on the published literature, for patients with a chronic alcohol use disorder admitted to the ICU with symptoms that may mimic or mask Wernicke's encephalopathy, we suggest abandoning the banana bag and utilizing the following formula for routine supplementation during the first day of admission: 200-500 mg IV thiamine every 8 hours, 64 mg/kg magnesium sulfate (approximately 4-5 g for most adult patients), and 400-1,000 μg IV folate. If alcoholic ketoacidosis is suspected, dextrose-containing fluids are recommended over normal saline.