Journal of critical care
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Journal of critical care · Oct 2011
Randomized Controlled Trial Comparative StudyAn open-labelled randomized controlled trial comparing costs and clinical outcomes of open endotracheal suctioning with closed endotracheal suctioning in mechanically ventilated medical intensive care patients.
Closed endotracheal suctioning (CES) may impact ventilator-associated pneumonia (VAP) risk by reducing environmental contamination. In developing countries where resource limitations constrain the provision of optimal bed space for critically ill patients, CES assumes greater importance. ⋯ In the ICU setting in a developing country, CES may be advantageous in reducing the incidence of VAP, particularly late-onset VAP. These results mandate further studies in this setting before specific guidelines regarding the routine use of CES are proposed.
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Journal of critical care · Oct 2011
Multicenter StudyOutcome of reintubated patients after scheduled extubation.
The main objective of study was to evaluate the outcome of patients who require reintubation after elective extubation. ⋯ In a large cohort of scheduled extubated patients, one third of patients developed extubation failure, of whom half needed reintubation. Reintubation was associated with increased mortality due to the development of new complications after reintubation.
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Journal of critical care · Oct 2011
ReviewA systematic review of short courses for nonspecialist education in intensive care.
The availability of reliable and accessible educational material for the training of nonspecialist intensive care physicians is potentially advantageous. We assessed the availability, cost, and content of generic short courses designed to teach basic critical care skills to junior physicians or nonspecialist intensive care physicians taking up duties in intensive care units. ⋯ Both identified courses use a mixture self-learning, didactic lectures, and experiential learning using manikins and "minisimulations." Organizing bodies provide administrative support and can readily be located and contacted online. Basic Assessment and Support in Intensive Care charges no license fee, whereas Fundamental Critical Care Support offers fees at a reduced rate for developing countries. Both courses are recognized and conducted internationally.
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Journal of critical care · Oct 2011
Comparative StudyConsent in critical care trials: a survey of Canadian research ethics boards and critical care researchers.
Reliance on third party consent for patients without decision-making capacity presents unique challenges for critical care research. We compared the attitudes and beliefs of Canadian research ethics boards (REBs) and intensive care unit researchers toward the use of various consent models for a low-risk randomized controlled trial. ⋯ In this survey of scenarios involving low-risk critical care research, REBs were significantly more conservative in approving alternative consent models compared with investigators.
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Journal of critical care · Oct 2011
Multicenter StudyNonhematological organ dysfunction and positive fluid balance are important determinants of outcome in adults with severe dengue infection: a multicenter study from India.
The purpose of the study was to explore determinants of outcome in adults with dengue hemorrhagic fever or dengue shock syndrome. ⋯ In our cohort, outcome from severe dengue was primarily related to nonhematological organ failure. Low serum albumin concentration on ICU admission and a more positive fluid balance at 72 hours were also associated with worse outcomes.