Articles: intensive-care-units.
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Background: This PICO-guided systematic review assessed continuous lateral rotation therapy (CLRT) versus conventional position changes in mechanically ventilated critically ill adults, evaluating mortality, intensive care unit (ICU) and hospital stay duration as primary outcomes, and respiratory function, mechanical ventilation duration, pulmonary complications, and adverse events, as secondary outcomes. Methods: A systematic review followed PRISMA criteria (PROSPERO CRD42022384258). Searches spanned databases: MEDLINE/PubMed, EMBASE, Scopus, ScienceDirect, Cochrane, CINAHL and Web of Science, without language or publication year restrictions. ⋯ CLRT showed no significant impact on mortality (OR 1.04, CI 0.80 to 1.34, p= 0.77), ICU stay (SMD -0.11 days, CI -0.25 to 0.02, p= 0.11), hospital stay (SMD -0.10 days, CI -0.31 to 0.11, p= 0.33) and incidence of pressure ulcers (OR 0.73, CI 0,34 to 1.60, p= 0.44). Conclusions: CLRT showed no significant difference in primary outcomes (mortality, ICU, and hospital stay duration) but revealed significant differences in secondary outcomes (consistently reduced nosocomial pneumonia, with a minor effect on MV duration), supported by moderate certainty. Very low certainty for other outcomes highlights the need for current studies in diverse clinical settings and protocols to assess CLRT effectiveness.
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Randomized Controlled Trial
Modelling the potential increase in eligible participants in clinical trials with inclusion of community intensive care units patients in Alberta, Canada: a decision tree analysis.
Critical care research in Canada is conducted primarily in academically affiliated intensive care units (ICUs) with established research infrastructure. Efforts are made to engage community hospital ICUs in research, although the impacts of their inclusion in clinical research have never been explicitly quantified. We therefore sought to determine the number of additional eligible patients that could be recruited into critical care trials and the change in time to study completion if community ICUs were included in clinical research. ⋯ Inclusion of community ICU patients in critical care research trials has the potential to substantially increase enrolment and decrease time to trial completion.
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Data science has the potential to greatly enhance efforts to translate evidence into practice in critical care. The intensive care unit is a data-rich environment enabling insight into both patient-level care patterns and clinician-level treatment patterns. By applying artificial intelligence to these novel data sources, implementation strategies can be tailored to individual patients, individual clinicians, and individual situations, revealing when evidence-based practices are missed and facilitating context-sensitive clinical decision support. To achieve these goals, technology developers should work closely with clinicians to create unbiased applications that are integrated into the clinical workflow.
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Curr Opin Crit Care · Jun 2024
ReviewAntimicrobial stewardship and molecular diagnostics: a symbiotic approach to combating resistance in the ED and ICU.
This review aims to evaluate the incorporation of rapid molecular diagnostics (RMD) in antimicrobial stewardship programs (ASPs) in the management of patients in the emergency department (ED) and intensive care unit (ICU), highlighting a shift from conventional microbiological diagnostic tests to RMD strategies to optimize antimicrobial use and improve patient outcomes. ⋯ RMD hold great value in simplifying patient management and mitigating antimicrobial exposure, particularly in settings with high levels of antimicrobial resistance where the use of broad-spectrum antimicrobials is high. While the impact on the use of antimicrobials is significant, the impact on patient outcomes is not yet clear. Successful integration of RMD in clinical decision making in the ED and ICU requires a team approach and continued education, and its use should be adapted to the local epidemiology and infrastructure.