Journal of critical care
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Journal of critical care · Feb 2013
Multicenter StudyRates and determinants of informed consent: a case study of an international thromboprophylaxis trial.
Successful completion of randomized trials depends upon efficiently and ethically screening patients and obtaining informed consent. Awareness of modifiable barriers to obtaining consent may inform ongoing and future trials. ⋯ Characteristics of study centers, research infrastructure, and experience were important factors associated with successfully procuring informed consent to participate in this thromboprophylaxis trial.
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Journal of critical care · Feb 2013
Multicenter Study Comparative StudyInterobserver agreement rate of the spontaneous breathing trial.
During the mechanical ventilation weaning process, the spontaneous breathing trial (SBT) is the confirmatory test of patients' capability to breathe unassisted. However, the SBT interobserver agreement rate (its reliability) is unknown, and our objective was to evaluate it. ⋯ The SBT interobserver agreement rate is only moderate for physicians and RT. The percentage of agreement between 2 different SBT observers is 79.2% to 92.3%. Therefore, a relevant percentage of patients will have different extubation decisions depending on the SBT observer.
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Resuscitation has the ability to reverse premature death. It can also prolong terminal illness, increase discomfort, and consume resources. The do-not-resuscitate (DNR) order and advance directives are still a debated issue in critical care. ⋯ There is evidence of the lack of DNR order policy worldwide. Therefore, it appears clear that there is a need for standardization. To improve the attitude about the DNR order, it is necessary to achieve several goals such as: increased communication, consensus on law, increased trust among patients and health care systems, and improved standards and quality of care to respect the patient's will and the family's role.
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Journal of critical care · Feb 2013
Comparative StudyA comparison of the rapid shallow breathing index and complexity measures during spontaneous breathing trials after cardiac surgery.
Extubation failure is associated with worse outcomes. Physicians use respiratory parameters to help them to decide to extubate or not. The purpose of this study is to determine if novel measures of respiratory physiology such as complexity and variability can identify patients who will tolerate extubation. ⋯ Patients who successfully tolerate extubation have longer interbreath interval with greater complexity and variability of that series. Although the V(T) was similar between the Extub-Success and the SBT-Fail groups, the Extub-Success group had greater long-term complexity with no difference in short-term complexity. This implies that the respiratory controllers are differently impacted in patients tolerating or not tolerating extubation.
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Journal of critical care · Feb 2013
ReviewBest interests at end of life: an updated review of decisions made by the Consent and Capacity Board of Ontario.
To increase our understanding of the notion of "best interests" in end of life disagreements through an updated review of decisions made by the Consent and Capacity Board of Ontario. There was a significant increase (235%) in decisions from this tribunal between 2009 and 2011. "Best interests" test is used when no prior expressed wishes are known to the surrogate decision-makers. ⋯ Several lessons are drawn for the benefit of health care teams engaged in disagreements at end of life with SDMs over the best interests of patients.