Journal of critical care
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This study evaluated the use of off-label medications in the intensive care unit (ICU) setting and their varying levels of evidence. ⋯ The use of off-label medication therapies in the US adult critical care units is common, a majority of which are initiated after admission to the ICU and a significant portion of which are supported with inferior levels of evidence.
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Journal of critical care · Feb 2011
Comparative StudyResidents' and nurses' perceptions of team function in the medical intensive care unit.
Team-based care is integral to modern intensive care units (ICUs). Trainee physicians ("residents") serve as core team members who provide direct patient care in academic ICUs. However, little is known about how resident perceptions of ICU team function differ from those of other disciplines. Therefore, we compared residents' perceptions to those of nurses', the other predominant direct caregiver group, in the medical ICU. ⋯ We found important differences in the way that ICU nurses and medical trainee physicians, the predominant types of providers caring for the critically ill in academic medical center ICUs, perceive key aspects of team function. These results may be useful to those responsible for administering academic ICUs as well as to residency program directors developing communication- and team-based curricula.
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Journal of critical care · Feb 2011
Risk factors and mortality of nosocomial infections of methicillin-resistant Staphylococcus aureus in an intensive care unit.
Methicillin-resistant Staphylococcus aureus (MRSA) infections are an increasing worldwide problem. We determined risk factors and predictors of mortality of MRSA nosocomial infections (NIs). ⋯ Methicillin resistance is very common with S aureus infection. In our intensive care unit, use of invasive devices/procedures and LOS were the most important risk factors for infection.
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Journal of critical care · Feb 2011
High circulating N-terminal pro-B-type natriuretic peptide is associated with greater systolic cardiac dysfunction and nonresponsiveness to fluids in septic vs nonseptic critically ill patients.
It is still unclear whether circulating levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) reflect cardiac filling and function in the critically ill patient, particularly during sepsis and a proinflammatory response that may induce NT-proBNP release from the heart. ⋯ Our data suggest that an increased circulating NT-proBNP plasma level is an independent marker of greater systolic cardiac dysfunction, irrespective of filling status, and is a better predictor of fluid nonresponsiveness in septic vs nonseptic, critically ill patients.
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Journal of critical care · Feb 2011
Swallowing dysfunction after mechanical ventilation in trauma patients.
Swallowing dysfunction can occur after mechanical ventilation, leading to complications such as aspiration and pneumonia. After mechanical ventilation, authors have recommended evaluating patients with contrast studies or endoscopy to identify patients at risk for swallowing dysfunction and aspiration. The purpose of the study was to determine if a bedside swallowing evaluation (BSE) can identify patients with swallowing dysfunction after mechanical ventilation. ⋯ A simple BSE can be used to identify patients at risk for swallowing dysfunction after mechanical ventilation. More importantly, BSE can safely clear patients without swallowing dysfunction, avoiding costly and time-consuming contrast studies or endoscopic evaluation.