Journal of critical care
-
Journal of critical care · Jun 2013
Consecutive thrombelastography clot strength profiles in patients with severe sepsis and their association with 28-day mortality: a prospective study.
The aim of this study was to assess associations between consecutive thrombelastography (TEG) profiles and standard coagulation tests and disease severity and mortality in patients with severe sepsis. ⋯ The ICU admission TEG MA remained constant for several days in patients with severe sepsis and hypocoagulable MA independently predicted 28-day mortality.
-
Journal of critical care · Jun 2013
A conceptual approach to improving care in pandemics and beyond: severe lung injury centers.
The events of the 2009 influenza pandemic sparked discussion regarding the need to optimize delivery of care to those most severely ill. We propose in this conceptual study that a tiered regionalization care system be instituted for patients with severe acute respiratory distress syndrome. Such system would be a component of national pandemic plans and could also be used in day-to-day operations.
-
Journal of critical care · Jun 2013
Contributions of tele-intensive care unit (Tele-ICU) technology to quality of care and patient safety.
The deployment of remote monitoring of intensive care unit (ICU) patients, known as tele-ICU technology, promotes the efficient use of critical care resources. Although tele-ICU use has spread rapidly, the benefits vary widely among studies, and little is known about the specific characteristics of tele-ICU that provide benefits to patient care. The purpose of this study was to identify aspects of tele-ICU that contribute, whether positively or negatively, to care processes and patient outcomes. ⋯ We found that availability of extra resources can reduce on mortality and length of stay, that a tele-ICU could serve as a quality trigger to improve evidence-based medicine compliance, that tele-ICU can support medication management and improve medication safety, and that tele-ICU software alerts and monitoring by camera can help reduce the risk of patient falls and extubations. We also found that tele-ICU physicians can make poor care decisions leading to medication errors if they lack patient-related information. Moreover, the tele-ICU has no impact on patient care processes and outcomes when the technology is not accepted and used by ICU staff.
-
Journal of critical care · Jun 2013
Perioperative plasma melatonin concentration in postoperative critically ill patients: its association with delirium.
Delirium is a common complication in postoperative critically ill patients. Although abnormal melatonin metabolism is thought to be one of the mechanisms of delirium, there have been few studies in which the association between alteration of perioperative plasma melatonin concentration and postoperative delirium was assessed. ⋯ Delta melatonin concentration at 1 hour after the operation has a significant independent association with risk of postoperative delirium.
-
Journal of critical care · Jun 2013
Delirium assessment using Confusion Assessment Method for the Intensive Care Unit in Chinese critically ill patients.
The aim of this study was to provide a method for delirium evaluation in simplified Chinese for patients speaking this language via validation of a translation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). ⋯ This study affirmed the validity and reliability against reference raters using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition of a brief nursing-conducted method of diagnosing delirium in ICU patients who speak simplified Chinese using the CAM-ICU.