Canadian respiratory journal : journal of the Canadian Thoracic Society
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To achieve national consensus on standards of training, quality assurance and maintenance of competence for critical care ultrasound for intensivists and critical care trainees in Canada using recently published international training statements. ⋯ Consensus was achieved to direct training curriculum, oversight, quality assurance and maintenance of competence for critical care ultrasound. In providing the first national guideline of its kind, these Canadian recommendations may also serve as a model of critical care ultrasound dissemination for other countries.
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The present article reviews recent advances in pulmonary computed tomography (CT) imaging, focusing on the application of dual-energy CT and the use of iterative reconstruction. Dual-energy CT has proven to be useful in the characterization of pulmonary blood pool in the setting of pulmonary embolism, characterization of diffuse lung parenchymal diseases, evaluation of thoracic malignancies and in imaging of lung ventilation using inhaled xenon. The benefits of iterative reconstruction have been largely derived from reduction of image noise compared with filtered backprojection reconstructions which, in turn, enables the use of lower radiation dose CT acquisition protocols without sacrificing image quality. Potential clinical applications of iterative reconstruction include imaging for pulmonary nodules and high-resolution pulmonary CT.
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Observational Study
Deferred consent in a minimal-risk study involving critically ill subarachnoid hemorrhage patients.
Alterations from first-party and surrogate decision-maker consent can enhance the feasibility of research involving critically ill patients. ⋯ Further research and enhanced awareness of the potential utility of hybrid models, including deferred consent in addition to patient or surrogate consent, in the conduct of low-risk and minimally interventional time-sensitive studies of critically ill patients are required.
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A subset of critically ill patients have end-of-life (EOL) goals that are unclear. Rapid response teams (RRTs) may aid in the identification of these patients and the delivery of their EOL care. ⋯ A change in EOL status following RRT-led EOL discussion was associated with reduced ICU transfers and enhanced access to palliative care services. Further study is required to identify and deconstruct barriers impairing timely and appropriate EOL discussions.
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Review Case Reports
Management of necrotizing pneumonia and pulmonary gangrene: a case series and review of the literature.
Necrotizing pneumonia is an uncommon but severe complication of bacterial pneumonia, associated with high morbidity and mortality. The availability of current data regarding the management of necrotizing pneumonia is limited to case reports and small retrospective observational cohort studies. Consequently, appropriate management for these patients remains unclear. ⋯ Necrotizing pneumonia often leads to pulmonary gangrene. Computed tomography of the thorax with contrast is recommended to evaluate the pulmonary vascular supply. Further study is necessary to determine whether surgical intervention, in the absence of pulmonary gangrene, results in better outcomes.