Crit Care Resusc
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Comparative Study
Modifications to predefined rapid response team calling criteria: prevalence, characteristics and associated outcomes.
Standardised rapid response team (RRT) calling criteria may not be applicable to all patients, and thus, modifications of these criteria may be reasonable to prevent unnecessary calls. Little data are available regarding the efficacy or safety of modifying RRT calling criteria; therefore, this study aimed to detail the prevalence and characteristics of modifications to RRT call triggers and explore their relationship with patient outcomes. ⋯ Modifications to standard calling criteria were frequently made, but did not seem to prevent further RRT calls and were associated with increased mortality. These findings suggest that modifications should be made with caution.
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Observational Study
"Likely overassistance" during invasive pressure support ventilation in patients in the intensive care unit: a multicentre prospective observational study.
To evaluate the prevalence of "likely overassistance" (categorised by respiratory rate [RR] ≤ 17 breaths/min or rapid shallow breathing index [RSBI] ≤ 37 breaths/min/L) during invasive pressure support ventilation (PSV), and the additional prevalence of fixed ventilator settings. ⋯ In a cohort of Victorian hospitals in Australia, during invasive PSV, "likely overassistance" was common, and the pressure support level was delivered in a standardised and unadjusted manner at 10 cmH2O, resulting in the frequent delivery of potentially injurious VT.
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Low tidal volume ventilation (LTVV) of 4-8 mL/kg of ideal body weight (IBW) reduces mortality in patients with acute respiratory distress syndrome, and, more recently, it has been recommended as the default therapy for all controlled ventilation. However, adherence to LTVV is poor. Barriers to adherence include not having height measurements taken or IBW calculated during admission. The aim of our project was to develop and validate a simple one step biometric measuring tool to directly estimate tidal volume (VT) in ventilated patients based on their demispan. ⋯ Estimating VT using of our biometric one step approach based on demispan correlates well with VT derived from vertical height. The simplicity of its use and accuracy could lead to improved adherence in a large cohort of patients who currently do not receive the recommended VT restriction.
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Lack of management guidelines for lifethreatening asthma (LTA) risks practice variation. This study aims to elucidate management practices of LTA in the intensive care unit (ICU). ⋯ In LTA, practice variation is common, with opportunities to improve discharge management plans and asthma education.