Journal of critical care
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Journal of critical care · Jun 2013
Full Outline of UnResponsiveness score and Glasgow Coma Scale in medical patients with altered sensorium: interrater reliability and relation to outcome.
Full Outline of UnResponsiveness, or FOUR score (FS), is a recently described scoring system for evaluation of altered sensorium. This study examined interrater reliability for FS and Glasgow Coma Scale (GCS) among medical patients with altered mental status and compared outcome predictability of GCS, FS, and Sequential Organ Failure Assessment score. ⋯ Interrater reliability and outcome predictability for FS were comparable with those for GCS. This study supports the use of FS for evaluation of altered mental status in the medical wards.
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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.
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Journal of critical care · Jun 2013
A structured educational intervention to improve targeted temperature management utilization after cardiac arrest.
Post-arrest targeted temperature management (TTM) has been shown to dramatically improve outcomes after resuscitation, yet studies have revealed inconsistent and slow adoption. Little is known about barriers to TTM implementation and methods to increase adoption. We hypothesized that a structured educational intervention might increase TTM use. ⋯ A focused TTM program led to increased confidence and usage among participants. Future work will focus on targeted training to address specific barriers and increase TTM utilization.
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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.
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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.