Critical care : the official journal of the Critical Care Forum
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Leroy and colleagues report on the accuracy of the Prolonged Mechanical Ventilation Prognostic Model ('ProVent') in a cohort study of patients ventilated for at least 21 days in one of three hospitals in the north of France. This study is noteworthy because it is the first to describe the performance of the ProVent model both outside the US and in a community hospital-based setting.
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Observational Study
Residents learning ultrasound-guided catheterization are not sufficiently skilled to use landmarks.
Ultrasound-guided (UG) technique is the recommended procedure for central venous catheterization (CVC). However, as ultrasound may not be available in emergency situations, guidelines also propose that physicians remain skilled in landmark (LM) placement. We conducted this prospective observational study to determine the learning curve of the LM technique in residents only learning the UG technique. ⋯ Residents who only learn the UG technique will not be immediately able to perform the LM technique, but require specific training based on at least 10 LM procedures. The question of whether or not the LM technique should still be taught when an ultrasound device is not available must therefore be addressed.
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The replacement, refinement, and reduction (3Rs) guidelines are the cornerstone of animal welfare practice for medical research. Nowadays, no animal research can be performed without being approved by an animal ethics committee. Therefore, we should expect that any published article would respect and promote the highest standard of animal welfare. ⋯ Animal welfare issues should be seen as an additional benefit to achieve this goal. It is therefore critical to draw conclusions from this study to improve the standard of animal welfare in critical care research. This has already been achieved in other fields of research, and we should follow their example.
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Early prediction of the outcome of patients with sepsis could be helpful in guiding therapies but remains challenging. Presepsin, a new sepsis biomarker whose elevation as early as day 1 is well correlated with 28-day mortality, could be considered to this end.