Articles: critical-care.
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Multicenter Study
Practice of expert critical care nurses in situations of prognostic conflict at the end of life.
Prolonging the living-dying process with inappropriate treatment is a profoundly disturbing ethical issue for nurses in many practice areas, including the intensive care unit. Despite the frequent occurrence of such distressing events, research suggests that critical care nurses assume a limited role in end-of-life decision making and care planning. ⋯ The transition from curative to end-of-life care in the intensive care unit is often fraught with ambiguity and anguish. The expert nurses demonstrated the ability and willingness to actively protect and advocate for their vulnerable patients even in situations in which the nurses' actions did not influence the outcomes.
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Anaesth Intensive Care · Aug 2006
Randomized Controlled Trial Multicenter StudyHighly conservative phlebotomy in adult intensive care--a prospective randomized controlled trial.
Anaemia in critically ill patients is common and phlebotomy associated blood loss may contribute towards this anaemia. The aims of this study were twofold. Firstly, a survey was conducted to provide a summary of current phlebotomy practices within Australian intensive care units. ⋯ Using our highly conservative protocol, median phlebotomy-associated blood loss was reduced by over 80% (40 ml vs 8 ml P<0.001). Mean haemoglobin fell from 13.7 g/dl to 11.7 g/dl in controls (P=0.002) and from 12.7 g/dl to 11.5 g/dl (P=0.074) in our study group. We conclude that highly conservative phlebotomy is feasible in a critical care unit and is associated with a reduction in blood loss.
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Journal of critical care · Jun 2006
Multicenter StudyDevelopment and implementation of a high-quality clinical database: the Australian and New Zealand Intensive Care Society Adult Patient Database.
To describe the development of a binational intensive care database. ⋯ A high-quality ICU database has successfully been implemented in Australia and New Zealand and is now used as a routine quality assurance and peer review tool. Similar developments may be both possible and desirable in other countries.
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Multicenter Study
Signs of critical conditions and emergency responses (SOCCER): a model for predicting adverse events in the inpatient setting.
Emergency response systems (ERS) are based on a set of triggers used to identify patients "at risk". This study aimed to establish the association between recordings of disturbed physiological variables and adverse events. ⋯ Both ES and LS were associated with adverse events. This study confirms the validity of current MET call criteria but points to the need to expand them. It provides a possible explanation for the failure to demonstrate efficacy of a MET in some trials because current call criteria maybe too late in the progress of the patient's critical condition. It allows the modelling of ERS and education programmes focused on signs of critical conditions. It potentially brings together ICU outreach and ward based responses. Broader use of clinical signs, monitoring such as pulse oximetry and objective data such as blood gas results may assist early intervention and help prevent loss of life.
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Critical care medicine · May 2006
Multicenter StudyRecalibration of risk prediction models in a large multicenter cohort of admissions to adult, general critical care units in the United Kingdom.
To assess the performance of published risk prediction models in common use in adult critical care in the United Kingdom and to recalibrate these models in a large representative database of critical care admissions. ⋯ Risk prediction models developed in another country require validation and recalibration before being used to provide risk-adjusted outcomes within a new country setting. Periodic reassessment is beneficial to ensure calibration is maintained.