Chest
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In response to the COVID-19 pandemic and as part of the statewide healthcare coalition response the Minnesota Critical Care Working Group (CCWG), composed of Interprofessional leaders from the state's nine largest health systems was established and entrusted to plan and coordinate critical care support for Minnesota from March 2020 through July1, 2021. ⋯ CCWG developed statewide critical care surge strategies assisting healthcare organization response to COVID-19 surges, providing a platform for clinical and operational activities. Collaboration, trust, and teamwork between CCWG leaders and healthcare organizations was essential to success and serves as a model for future events.
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An increasing number of patients with pulmonary arterial hypertension (PAH) have cardiovascular comorbidities. However, the effects of comorbidities on responses to PAH treatment are not well understood. ⋯ This post hoc analysis suggests that patients with PAH and cardiovascular comorbidities can benefit from combination therapy with inhaled or oral treprostinil.
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Rapid assessment and treatment (RAT) calls, facilitated by Rapid Response Teams (RRTs), have become vital to the care of hospitalized patients deteriorating outside of the intensive care unit in many institutions worldwide. A significant body of data has recognized the efficacy of rapid response systems (RRSs) in improving patient care; however, there is no standardized protocol that all RRSs practice. Even when the recognition of patient clinical deterioration is rapidly noted, further treatment may be delayed due to issues with clinical knowledge and communication between parties present, especially in training institutions. ⋯ Finally, we re-assessed our responses to RAT calls post-intervention. We found that an educational intervention improved patient outcomes and several key process measures in our RRS. This article describes the process and lessons learned from our initiative.
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Acute circulatory failure is critical in ICU patients. CO2-O2-derived indices including the central venous-to-arterial CO2 difference (P(v-a)CO2 gap) and the P(v-a)CO2 gap/Ca-vO2 ratio are markers for global metabolic demand and tissue hypoxia. ⋯ Algorithm-based resuscitation using CO2-O2-derived indices did not improve lactate clearance or clinical outcomes compared to standard care. Further research needed to identify specific patient subgroups who may benefit from this approach.
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The integration of Nurse Practitioners (NPs) and Physician Assistants (PAs) in the Medical Intensive Care Unit (MICU) is becoming increasingly vital due to the rising number of critically ill patients and the shortage of board-certified intensivists. Successful recruitment and utilization of NPs and PAs into the MICU setting require a unique understanding of potential variations of the scope of practice based on state law and educational backgrounds, as well as the implementation of best practices around training and leadership support. The purpose of this article is to review the best strategies for creating a MICU team with NPs and PAs. ⋯ There are variations in state laws and institutional policies that impact NP and PA practice which should be understood by the organization to manage expectations for the NP and PA job responsibilities. Effective productivity measurement methods are proposed to accurately assess the contributions of NPs and PAs in the MICU. This paper provides comprehensive strategies for successfully hiring, onboarding, and integrating these professionals into MICU teams, ensuring high-quality care delivery in critical care settings.