Intensive care medicine
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Intensive care medicine · Jul 2018
Observational StudyOutcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA.
Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown. ⋯ Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life.
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Intensive care medicine · Jul 2018
Observational StudyEffects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study.
Chlorhexidine oral care is widely used in critically and non-critically ill hospitalized patients to maintain oral health. We investigated the effect of chlorhexidine oral care on mortality in a general hospitalized population. ⋯ These data argue against the indiscriminate widespread use of chlorhexidine oral care in hospitalized patients, in the absence of proven benefit in specific populations.
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Intensive care medicine · Jul 2018
Review Meta Analysis Comparative StudyLow-dose corticosteroids for adult patients with septic shock: a systematic review with meta-analysis and trial sequential analysis.
To assess the effect of low dose corticosteroids on outcomes in adults with septic shock. ⋯ In adults with septic shock treated with low dose corticosteroids, short- and longer-term mortality are unaffected, adverse events increase, but duration of shock, mechanical ventilation and ICU stay are reduced. PROSPERO registration no. CRD42017084037.
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Intensive care medicine · Jul 2018
Impact of the driving pressure on mortality in obese and non-obese ARDS patients: a retrospective study of 362 cases.
The relation between driving pressure (plateau pressure-positive end-expiratory pressure) and mortality has never been studied in obese ARDS patients. The main objective of this study was to evaluate the relationship between 90-day mortality and driving pressure in an ARDS population ventilated in the intensive care unit (ICU) according to obesity status. ⋯ Contrary to non-obese ARDS patients, driving pressure was not associated with mortality in obese ARDS patients.
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Intensive care medicine · Jul 2018
Management and outcomes of acute respiratory distress syndrome patients with and without comorbid conditions.
The standard of care for patients with acute respiratory distress syndrome (ARDS) has been developed based on studies that usually excluded patients with major comorbidities. ⋯ Half the patients with ARDS had major comorbidities, which were associated with severe ARDS, multiple organ dysfunction, and day-28 mortality. These findings do not support the exclusion of ARDS patients with severe comorbidities from randomized clinical trials. Trials in ARDS patients with whatever comorbidities are warranted.