Articles: patients.
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Minerva anestesiologica · Jun 2013
LACTATE or ScvO2 as an endpoint in resuscitation of shock states?
In the current management of critically ill patients, variables such as blood pressure, urine output or central venous pressure guide resuscitative efforts. Unfortunately, global tissue hypoxia may persist leading to multiple organ failure and death. To address tissue well-being, indices such as central venous oxygen saturation (ScvO2) and lactataemia are widely used and are strongly linked to outcome. ⋯ Herein, we review the physiology and rationale for ScvO2 and lactate monitoring. Clinical uses, evidence-based outcome implications and limitations are also examined to aid the clinician in daily practice. Key words: lactate, central venous oxygen saturation, shock, goal-directed therapy.
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Critical care medicine · Jun 2013
Effect of a Multifaceted Performance Feedback Strategy on Length of Stay Compared With Benchmark Reports Alone: A Cluster Randomized Trial in Intensive Care.
To assess the impact of applying a multifaceted activating performance feedback strategy on intensive care patient outcomes compared with passively receiving benchmark reports. DESIGN:: The Information Feedback on Quality Indicators study was a cluster randomized trial, running from February 2009 to May 2011. SETTING:: Thirty Dutch closed-format ICUs that participated in the national registry. Study duration per ICU was sixteen months. PATIENTS:: We analyzed data on 25,552 admissions. Admissions after coronary artery bypass graft surgery were excluded. INTERVENTION:: The intervention aimed to activate ICUs to undertake quality improvement initiatives by formalizing local responsibility for acting on performance feedback, and supporting them with increasing the impact of their improvement efforts. Therefore, intervention ICUs established a local, multidisciplinary quality improvement team. During one year, this team received two educational outreach visits, monthly reports to monitor performance over time, and extended, quarterly benchmark reports. Control ICUs only received four standard quarterly benchmark reports. MEASUREMENTS AND ⋯ In the context of ICUs participating in a national registry, applying a multifaceted activating performance feedback strategy did not lead to better patient outcomes than only receiving periodical registry reports.