Critical care medicine
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Critical care medicine · Apr 2022
Multicenter Study Observational StudyBenchmarking Inpatient Mortality Using Electronic Medical Record Data: A Retrospective, Multicenter Analytical Observational Study.
To develop a model to benchmark mortality in hospitalized patients using accessible electronic medical record data. ⋯ Variables considered by traditional ICU prognostic models accurately benchmark patient mortality for patients receiving care in multiple hospital locations, not only the ICU. Unlike Acute Physiology and Chronic Health Evaluation, this model relies on electronic medical record data alone and does not require personnel to collect the independent predictor variables. Assessing the model's utility for benchmarking hospital performance will require prospective testing in a larger representative sample of hospitals.
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Critical care medicine · Apr 2022
The Return on Investment of a Province-Wide Quality Improvement Initiative for Reducing In-Hospital Sepsis Rates and Mortality in British Columbia, Canada.
Sepsis is a life-threatening medical emergency. There is a paucity of information on whether quality improvement approaches reduce the in-hospital sepsis caseload or save lives and decrease the healthcare system and society's cost at the provincial/national levels. This study aimed to assess the outcomes and economic impact of a province-wide quality improvement initiative in Canada. ⋯ British Columbia Sepsis Network appears to have averted a greater number of sepsis cases and deaths in British Columbia than the national average and yielded a positive return on investment. Our findings strengthen the policy argument for targeted quality improvement initiatives for sepsis care and provide a model of care for other provinces in Canada and elsewhere globally.
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Critical care medicine · Apr 2022
Observational StudyAssociation of Catecholamine Dose, Lactate, and Shock Duration at Vasopressin Initiation With Mortality in Patients With Septic Shock.
To determine the association of catecholamine dose, lactate concentration, and timing from shock onset at vasopressin initiation with in-hospital mortality. ⋯ Higher norepinephrine-equivalent dose at vasopressin initiation and higher lactate concentration at vasopressin initiation were each associated higher in-hospital mortality in patients with septic shock who received vasopressin.
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Critical care medicine · Apr 2022
Randomized Controlled Trial Comparative StudyUse of Airway Pressure Release Ventilation in Patients With Acute Respiratory Failure Due to Coronavirus Disease 2019: Results of a Single-Center Randomized Controlled Trial.
Airway pressure release ventilation is a ventilatory mode characterized by a mandatory inverse inspiratory:expiratory ratio with a very short expiratory phase, aimed to avoid derecruitment and allow spontaneous breathing. Recent basic and clinical evidence suggests that this mode could be associated with improved outcomes in patients with acute respiratory distress syndrome. The aim of this study was to compare the outcomes between airway pressure release ventilation and traditional ventilation targeting low tidal volume, in patients with severe coronavirus disease 2019. ⋯ In conclusion, when compared with low tidal volume, airway pressure release ventilation was not associated with more ventilator-free days or improvement in other relevant outcomes in patients with severe coronavirus disease 2019.