Critical care medicine
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Critical care medicine · Feb 2018
Multicenter Study Comparative Study Observational StudyHospital Differences Drive Antibiotic Delays for Black Patients Compared With White Patients With Suspected Septic Shock.
Evaluate racial disparities in sepsis processes of care. ⋯ Black patients appear to be less likely than white patients to receive timely antibiotic therapy for sepsis. These differences were largely explained by variation in care among hospitals, such that hospitals that disproportionately treat black patients were less likely to provide timely antibiotic therapy overall. There were no differences between races in other sepsis quality measures or adjusted mortality.
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Critical care medicine · Feb 2018
Multicenter StudyRenal Replacement Therapy Modality in the ICU and Renal Recovery at Hospital Discharge.
Acute kidney injury requiring renal replacement therapy is a major concern in ICUs. Initial renal replacement therapy modality, continuous renal replacement therapy or intermittent hemodialysis, may impact renal recovery. The aim of this study was to assess the influence of initial renal replacement therapy modality on renal recovery at hospital discharge. ⋯ In this large retrospective study, intermittent hemodialysis as an initial modality was associated with lower renal recovery at hospital discharge among patients with acute kidney injury, although the difference seems somewhat clinically limited.
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Critical care medicine · Feb 2018
Multicenter StudyImpact of Quality Bundle Enforcement by a Critical Care Pharmacist on Patient Outcome and Costs.
Surgical and medical ICU patients are at high risk of mortality and provide a significant cost to the healthcare system. The aim of this study is to describe the effect of pharmacist-led interventions on drug therapy and clinical strategies on ICU patient outcome and hospital costs. ⋯ Critical care pharmacist-led interventions were associated with decreases in ICU and hospital length of stays and ICU drug costs.
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Critical care medicine · Feb 2018
Observational StudyAcute Physiologic Stress and Subsequent Anxiety Among Family Members of ICU Patients.
The ICU is a complex and stressful environment and is associated with significant psychologic morbidity for patients and their families. We sought to determine whether salivary cortisol, a physiologic measure of acute stress, was associated with subsequent psychologic distress among family members of ICU patients. ⋯ Roughly one third of family members experience anxiety after an ICU admission for their loved one, and many family members also experience depression and posttraumatic stress. Cortisol awakening response is associated with anxiety in family members of ICU patients 3 months following the ICU admission. Physiologic measurements of stress among ICU family members may help identify individuals at particular risk of adverse psychologic outcomes.
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Critical care medicine · Feb 2018
Comparative StudyThe Present State of Neurointensivist Training in the United States: A Comparison to Other Critical Care Training Programs.
This manuscript describes the state of neurocritical care fellowship training, compares its written standards to those of other critical care fellowship programs, and discusses how programmatic oversight by the United Council for Neurological Subspecialties should evolve to meet American College of Graduate Medical Education standards. This review is a work product of the Society of Critical Care Medicine Neuroscience section and was reviewed and approved by the Council of the Society of Critical Care Medicine. ⋯ The United Council for Neurologic Subspecialties has developed a directed program development strategy to emulate American College of Graduate Medical Education standards with the goal to have standards that are similar or identical to American College of Graduate Medical Education standards.