Journal of critical care
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The purpose of this study is to describe the effect of levosimendan (without loading dose) on hemodynamics, inotropes/vasopressors, and mortality in acute heart failure (AHF). ⋯ Levosimendan, without a loading dose, improved cardiac index and perfusion while allowing a reduction in inotropic/vasopressor requirements in patients with AHF.
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Journal of critical care · Dec 2013
Six-day postoperative impact of a standardized nurse observation and escalation protocol: A preintervention and postintervention study.
The purpose of the study is to determine the impact of a standardized nurse observation and escalation protocol on observation frequency, the measurement of vital signs, and the incidence of in-hospital mortality and resurgery. ⋯ The mean patient observation frequency per nursing shift increased from 0.9076 (95% confidence interval [CI], 0.8921-0.9231) preintervention to 0.9940 (95% CI, 0.9708-1.0172; P < .001) postintervention and was lower in case of 6-day postoperative mortality (0.6686 [95% CI, 0.4984-0.8388] vs other patients 0.9475 [95% CI, 0.9340-0.9610]; P = .003) or resurgery (0.8402 [95% CI, 0.7894-0.8909] vs other patients 0.9564 [95% CI, 0.9378-0.9657]; P = .003). The mean number of vital signs measured per observation episode increased from a mean of 1.81 (95% CI, 1.79-1.83) preintervention to 2.45 (95% CI, 2.39-2.51; P < .001) postintervention. The relative risk reduction was 73.7% (95% CI, 22.8-91.0; P = .015) for 6-day postoperative in-hospital mortality and 30.9% (95% CI, 9.5-47.2; P = .007) for 6-day postoperative resurgery.
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Journal of critical care · Dec 2013
Analysis of the variations between Accreditation Council for Graduate Medical Education requirements for critical care training programs and their effects on the current critical care workforce.
Adult critical care medicine (CCM) is ill prepared for the demands of an aging US population. Sources have acknowledged a severe shortage of intensivists, yet there has been minimal discussion on the lack of critical care training opportunities. Inconsistencies in training options have led to fragmentation of how critical care services are provided to the US adult population. ⋯ Internal medicine offers the greatest pool of candidates to practice full-time CCM, yet there are minimal opportunities for internists wanting to go into straight CCM without also receiving pulmonary training. However, because many PCCM physicians spend a significant amount of time outside critical care, current PCCM training options do not meet the demand for critical care physicians. In this article, we review the barriers to critical care training opportunities and expanding the intensivist workforce and propose reasonable and practical solutions.