Articles: critical-illness.
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Critical care medicine · Apr 2012
Randomized Controlled TrialCognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomized controlled pilot investigation.
Millions of patients who survive medical and surgical general intensive care unit care every year experience newly acquired long-term cognitive impairment and profound physical and functional disabilities. To overcome the current reality in which patients receive inadequate rehabilitation, we devised a multifaceted, in-home, telerehabilitation program implemented using social workers and psychology technicians with the goal of improving cognitive and functional outcomes. ⋯ A multicomponent rehabilitation program for intensive care unit survivors combining cognitive, physical, and functional training appears feasible and possibly effective in improving cognitive performance and functional outcomes in just 3 months. Future investigations with a larger sample size should be conducted to build on this pilot feasibility program and to confirm these results, as well as to elucidate the elements of rehabilitation contributing most to improved outcomes.
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Randomized Controlled Trial Comparative Study
Effect of a computerized insulin dose calculator on the process of glycemic control.
Glycemic control is important to patients' outcomes. However, the process of maintaining glycemic control is risk laden and labor intensive for nurses. ⋯ Management of glycemic control and nurse satisfaction were improved with use of the dose calculator. Improving nurses' processes of care may improve nurses' use of time and patient care overall. Studies with larger sample sizes over time are needed to determine these relationships.
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Randomized Controlled Trial Multicenter Study Comparative Study
The role of the endotracheal tube cuff in microaspiration.
The cuff of the endotracheal tube (ETT) is designed to provide a seal within the airway, allowing airflow through the ETT but preventing passage of air or fluids around the ETT. Deliberate or inadvertent movement of the ETT may affect cuff pressure or shift folds in the cuff, mobilizing pooled secretions. ⋯ These complications are costly in terms of morbidity and mortality, as well as hospital expense. We will discuss the role of the ETT cuff in microaspiration and identify potential directions for future research to improve outcomes in mechanically ventilated patients.
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Pediatr Crit Care Me · Mar 2012
Randomized Controlled Trial Comparative StudyThe randomized comparative pediatric critical illness stress-induced immune suppression (CRISIS) prevention trial.
Nosocomial infection/sepsis occurs in up to 40% of children requiring long-term intensive care. Zinc, selenium, glutamine, metoclopramide (a prolactin secretalogue), and/or whey protein supplementation have been effective in reducing infection and sepsis in other populations. We evaluated whether daily nutriceutical supplementation with zinc, selenium, glutamine, and metoclopramide, compared to whey protein, would reduce the occurrence of nosocomial infection/sepsis in this at-risk population. ⋯ Compared with whey protein supplementation, zinc, selenium, glutamine, and intravenous metoclopramide conferred no advantage in the immune-competent population. Further evaluation of zinc, selenium, glutamine, and intravenous metoclopramide supplementation is warranted in the immunocompromised long-term pediatric intensive care unit patient.
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Critical care medicine · Feb 2012
Randomized Controlled Trial Multicenter Study Comparative StudyA multifaceted program for improving quality of care in intensive care units: IATROREF study.
To test the effects of three multifaceted safety programs designed to decrease insulin administration errors, anticoagulant prescription and administration errors, and errors leading to accidental removal of endotracheal tubes and central venous catheters, respectively. Medical errors and adverse events are associated with increased mortality in intensive care patients, indicating an urgent need for prevention programs. ⋯ A multifaceted program was effective in preventing insulin errors and accidental tube/catheter removal. Significant Hawthorne effects occurred, emphasizing the need for appropriately designed studies before definitively implementing strategies.