Crit Care Resusc
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Multicenter Study
The association between early arterial oxygenation and mortality in ventilated patients with acute ischaemic stroke.
There are conflicting data that suggest that hyperoxia may be associated with either worse or better outcomes in patients suffering a stroke. ⋯ We found no association between worst arterial oxygen tension in the first 24 hours in ICU and outcome in ventilated patients with ischaemic stroke.
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To determine the impact on call characteristics and patient outcomes since the implementation of a two-tiered rapid-response system along with new observation charts and calling criteria. ⋯ Implementation of a two-tiered rapid-response system and new observation charts and calling criteria increased the number of rapid-response calls with a nonsignificant trend towards a decreased incidence of serious adverse events. Further improvements in care of hospitalised patients may be possible by preventing repeat calls or calls within 24 hours of hospital admission and discharge from acute care areas.
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Assessing the appropriateness of continuing life support is a difficult task for intensive care unit staff. Part of this difficulty relates to prognostic uncertainty and the varying reliability of clinical decisions. Uncertainty about prognosis is quickly recognised by patients and families, and can be a source of mistrust and potential conflict. ⋯ The family conference should develop an agreed plan through shared decision making. The collective wisdom of experienced health care workers with good communication skills and informed patient advocates increases the likelihood of achieving practical certainty and the best decisions. However, greater time and effort seems to be required to improve end-of-life care in the ICU.