Articles: intensive-care-units.
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Curr Opin Crit Care · Apr 2012
ReviewParenteral nutrition and calorie delivery in the ICU: controversy, clarity, or call to action?
This review will highlight recent data evaluating the role of parenteral nutrition and calorie delivery in the intensive care setting. Specific focus will be placed on recent trials of early and/or supplemental parenteral nutrition (SPN) and optimization of calorie delivery in ICU patients on the basis of nutrition risk and acuity of illness. The potential key role of protein delivery in outcome will also be discussed. ⋯ The conflicting results of recent RCTs of SPN have provided clarity into the factors defining which patients may benefit from additional calories/protein and which may not. These data, combined with key, large observational studies elicit a clear call to action for trials examining the benefit of optimal calorie/protein delivery in high mortality risk, high preillness nutrition risk patients.
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To critically evaluate the use of analgosedation in the management of agitation in critically ill mechanically ventilated patients. ⋯ Analgosedation is an efficacious and well-tolerated approach to management of ICU sedation with improved patient outcomes compared to sedative-hypnotic approaches. Additional well-designed trials are warranted to clarify the role of analgosedation in the management of ICU sedation, including trials with nonopioid analgesics.
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Delirium is frequently encountered in the ICU and is associated with significant adverse outcomes. The increasingly recognized consequences of ICU delirium should enhance efforts to improve recognition and management of this serious problem. We aim to review the recent literature on ICU delirium, including risk factors, detection, management and long-term impact of disease. ⋯ Delirium remains an underrecognized and underdiagnosed problem. Detection tools are readily available and easy to use. Further understanding of risk factors is needed to identify most susceptible individuals and plan management, which should include prevention and therapy based on available evidence.
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Comparative Study
Development of a pragmatic measure for evaluating and optimizing rapid response systems.
Standard metrics for evaluating rapid response systems (RRSs) include cardiac and respiratory arrest rates. These events are rare in children; therefore, years of data are needed to evaluate the impact of RRSs with sufficient statistical power. We aimed to develop a valid, pragmatic measure for evaluating and optimizing RRSs over shorter periods of time. ⋯ The critical deterioration rate is a valid, pragmatic proximate outcome associated with in-hospital mortality. It has great potential for complementing existing patient safety measures for evaluating RRS performance.
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We investigated the performance of the simplified acute physiology score II (SAPS II) in a large cohort of surgical intensive care unit (ICU) patients and tested the hypothesis that customization of the score would improve the uniformity of fit in subgroups of surgical ICU patients. ⋯ In this large cohort of surgical ICU patients, performance of the original SAPS II model was generally poor. Although second-level customization improved discrimination and calibration in the whole cohort and most of the subgroups, it failed to simultaneously improve calibration in the subgroups stratified according to the type of surgery, age or ICU LOS.