Journal of critical care
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Journal of critical care · Jun 2007
Multicenter Study Comparative StudyBarriers to implementing the Leapfrog Group recommendations for intensivist physician staffing: a survey of intensive care unit directors.
The Leapfrog Group, representing a consortium of health care purchasers, has promoted standards for intensive care unit (ICU) staffing in nonrural areas. The purpose of this study was to examine the perception of the Leapfrog standards among ICU directors and determine the potential barriers to implementing these standards. ⋯ Numerous barriers exist to implementing the Leapfrog recommendations for intensivist staffing, not the least of which is the lack of an ICU director in many hospitals. Better strategies are needed to overcome these barriers before the widespread adoption of an intensivist care model similar to Leapfrog is feasible.
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Journal of critical care · Jun 2007
Early evolution of arterial oxygenation in severe community-acquired pneumonia: a prospective observational study.
Acute respiratory failure requiring mechanical ventilation in severe community-acquired pneumonia has been shown to be a significant negative prognostic factor. We analyzed the early evolution of the Pao(2)/Fio(2) ratio and evaluated its clinical value as an outcome predictor. ⋯ A progressive improvement of Pao(2)/Fio(2) ratio during the first 48 hours of mechanical ventilation indicates favorable outcome. Serial measurement of this ratio should be considered in decision making for therapeutic strategy.
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Journal of critical care · Jun 2007
Long-term outcomes in patients requiring stay of more than 48 hours in the intensive care unit following coronary bypass surgery.
The primary objective of this study was to determine the long-term outcomes of all patients requiring prolonged intensive care unit (ICU) stay following coronary bypass surgery (CABG) surgery. ⋯ Prolonged ICU stay following CABG resulted in increased early and late mortality and lower freedom from readmission to hospital for cardiac reasons.
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Journal of critical care · Jun 2007
Challenges and rewards on the road to translational systems biology in acute illness: four case reports from interdisciplinary teams.
Translational systems biology approaches can be distinguished from mainstream systems biology in that their goal is to drive novel therapies and streamline clinical trials in critical illness. One systems biology approach, dynamic mathematical modeling (DMM), is increasingly used in dealing with the complexity of the inflammatory response and organ dysfunction. The use of DMM often requires a broadening of research methods and a multidisciplinary team approach that includes bioscientists, mathematicians, engineers, and computer scientists. However, the development of these groups must overcome domain-specific barriers to communication and understanding. ⋯ A transdisciplinary approach, which involves team interaction in an iterative fashion to address ambiguity and is supported by educational initiatives, is likely to be necessary for DMM in acute illness. Communitywide organizations such as the Society of Complexity in Acute Illness must strive to facilitate the implementation of DMM in sepsis/trauma research into the research community as a whole.