Articles: intensive-care-units.
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Minerva anestesiologica · Jul 2023
The power of mechanical ventilation may predict mortality in critically ill patients.
Mechanical power (MP) is the amount of energy transferred from the ventilator to the patient within a unit of time. It has been emphasized in ventilation-induced lung injury (VILI) and mortality. However, its measurement and use in clinical practice are challenging. "Electronic recording systems (ERS)" using mechanical ventilation parameters provided by the ventilator can be helpful to measure and record the MP. The MP (J/minutes) formula is 0.098 x tidal volume x respiratory rate x (Ppeak - ½ ∆P), in which ∆P is the driving pressure and Ppeak is the peak pressure. We aimed to define the association between MP values and ICU mortality, mechanical ventilation days, and intensive care unit length of stay (ICU-LOS). The secondary outcome was to determine the most potent or essential component of power in the equation that has a role in mortality. ⋯ The first 24 h MP maybe a predictive value for the ICU patients' prognosis. This implies that MP may be used as a decision-making system to define the clinical approach and as a scoring system to predict patient prognosis.
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Critical care clinics · Jul 2023
ReviewFour Decades of Intensive Care Unit Design Evolution and Thoughts for the Future.
Intensive care unit (ICU) design has changed since the mid-1980s. Targeting timing and incorporation of the dynamic and evolutionary processes inherent in ICU design is not possible nationally. ICU design will continue evolving to incorporate new concepts of best design evidence and practice, better understandings of the needs of patients, visitors and staff, unremitting advances in diagnostic and therapeutic approaches, ICU technologies and informatics, and the ongoing search to best fit ICUs within greater hospital complexes. As the ideal ICU remains a moving target; the design process should include the ability for an ICU to evolve into the future.
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Critical care clinics · Jul 2023
ReviewFrom Strict Bedrest to Early Mobilization: A History of Physiotherapy in the Intensive Care Unit.
Critically ill patients are at risk of post-intensive care syndrome, including physical, cognitive, and psychological sequelae. Physiotherapists are rehabilitation experts who focus on restoring strength, physical function, and exercise capacity. ⋯ Physiotherapists are assuming more prominent roles in clinical and research leadership, with opportunities for wider interdisciplinary collaboration. This paper reviews the evolution of critical care from a rehabilitation perspective, highlights relevant research milestones, and proposes future opportunities for improving survivorship outcomes.
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Anesthesia and analgesia · Jul 2023
Randomized Controlled TrialSleep Fragmentation, Electroencephalographic Slowing, and Circadian Disarray in a Mouse Model for Intensive Care Unit Delirium.
We aimed to further validate our previously published animal model for delirium by testing the hypothesis that in aged mice, Anesthesia, Surgery and simulated ICU conditions (ASI) induce sleep fragmentation, electroencephalographic (EEG) slowing, and circadian disarray consistent with intensive care unit (ICU) patients with delirium. ⋯ ASI mice experienced EEG and circadian changes mimicking those of delirious ICU patients. These findings support further exploration of this mouse approach to characterize the neurobiology of delirium.
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Critical care clinics · Jul 2023
ReviewCritical Care 1950 to 2022: Evolution of Medicine, Nursing, Technology, and Design.
Critical care units-designed for concentrated and specialized care-came from multiple parallel advances in medical, surgical, and nursing techniques and training taking advantage of new therapeutic technologies. Regulatory requirements and government policy impacted design and practice. ⋯ Hospitals offered newer, more extreme, and specialized surgeries and anesthesia enabled more complex procedures. ICUs developed in the 1950s, providing a recovery room's level of observation and specialized nursing to serve the critically ill, whether medical or surgical.