Chest
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Ventilator-associated pneumonia (VAP) rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs). ⋯ Patients in LMICs have a twofold higher risk of VAP, independent of bundle adherence. Prolonged mechanical ventilation was an independent predictor of VAP, while higher staffing ratios were associated with decreased risk for VAP development. Unmeasured factors like infrastructure and infection control practices may explain the higher VAP rates in LMICs.
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Airway management is a critical component of the care of patients experiencing cardiac arrest, but data from randomized trials on the use of video vs direct laryngoscopy for intubation in the setting of cardiac arrest are limited. Current AHA guidelines recommend placement of an endotracheal tube either during CPR or shortly after return of spontaneous circulation but do not provide guidance around intubation methods, including the choice of laryngoscope. ⋯ Among adults undergoing tracheal intubation after experiencing cardiac arrest, use of video laryngoscopy was associated with increased incidence of successful intubation on the first attempt and shortened duration of laryngoscopy, compared to use of direct laryngoscopy.
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Delirium is a common and serious syndrome of acute brain dysfunction associated with negative outcomes. Melatonin may have a role in delirium prevention for critically ill adults based on data from non-critically ill patient populations. Our objective was to assess the feasibility of a multi-centre, randomized, placebo-controlled trial testing the hypothesis that low-dose melatonin prevents delirium in critically ill adults. ⋯ Our trial protocol comparing two low doses of melatonin and placebo for delirium prevention in critically ill adults demonstrated feasibility for protocol adherence. However, trial eligibility rates were modest primarily due to delirium being present or the inability to screen. Consent rates were also low. This finding suggests that conducting delirium prevention trials that require delirium to be absent on enrolment is particularly challenging in the ICU.
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Accurate assessment of a patient's volume status is crucial in many conditions, informing decisions on fluid prescribing, vasoactive agents, and decongestive therapies. Determining a patient's volume status is challenging, due to limitations in examination and investigations and the complexities of fluid homeostasis in disease states. Point-of-care ultrasound (POCUS) is useful in assessing hemodynamic parameters related to volume status, fluid responsiveness, and fluid tolerance. It requires understanding several physiologic concepts to accurately interpret and integrate POCUS findings into volume-related clinical decision-making. ⋯ Volume status assessment is ubiquitous, yet challenging to perform. This review summarizes foundational physiologic concepts relevant to volume status evaluation, and highlights how multiorgan POCUS informs on hemodynamic parameters that can be combined with the conventional clinical assessment to make fluid-related decisions.
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Changes in body composition, including loss of muscle mass and obesity, adversely affect lung function. ⋯ Lung function was associated significantly with visceral adiposity and skeletal muscle quality, which differed according to sex and BMI. Improving lung function may require tailored management, including reducing visceral fat, enhancing skeletal muscle quality based on CT scan-body composition analysis, or both.