Journal of critical care
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Journal of critical care · Aug 2013
Multicenter StudyRapid response teams, do not resuscitate orders, and potential opportunities to improve end-of-life care: a multicentre retrospective study.
Rapid response teams (RRTs) were created to stabilize acutely ill patients on the ward, but recent studies suggest that RRTs may improve end-of-life care (EOLC). To learn more about the role of the RRT in EOLC at our institutions, we conducted a retrospective review. ⋯ RRT consultation is an important milestone for many patients approaching EOL. RRTs frequently participate in EOL discussions and decision-making, but they may miss opportunities to facilitate EOLC.
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Journal of critical care · Aug 2013
Dose modulation: a new concept of antibiotic therapy in the critically ill patient?
Considerable evidence has shown that adequate antibiotic therapy is of utmost importance in the critically ill septic patient. However, antibiotic concentration may be insufficient early in infection course. We propose the concept of dose modulation, meaning front-line variability of antibiotic dose, according to patient and microorganism characteristics, followed by its reduction after clinical response and patient recovery. Therefore, dose modulation means concentrating the largest weight of antibiotics at the front-end, when the microbial load is higher and the pharmacokinetic changes poses the highest risk of underdosing and nibbling off antibiotic dose, when the sepsis syndrome is improving, guided by pharmacokinetic and pharmacodynamic data.
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Journal of critical care · Aug 2013
Impact of bed availability on requesting and offering in-hospital intensive care unit transfers: a survey study of generalists and intensivists.
To evaluate whether bed availability affects a physician's decision to request or offer an intensive care unit (ICU) transfer. ⋯ There is high variability in the decision to request or offer ICU beds. There was not a significant association between bed availability and ICU transfer decisions.
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Journal of critical care · Aug 2013
Effectiveness of end-expiratory lung volume measurements during the lung recruitment maneuver for patients with atelectasis.
The aim of this study was to determine whether the relative change in the end-expiratory lung volume (EELV) obtained by the recruitment maneuver (RM) can serve as an indicator of the change in the P/F ratio. ⋯ These results suggest that the ΔEELV obtained by intermittent stepwise RM can serve as an indicator of the change in the P/F ratio.
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Journal of critical care · Aug 2013
Exhaled nitrite/nitrate levels as a marker of respiratory complications after heart valve surgery.
The purposes of this study are to measure the nitric oxide metabolites nitrite and nitrate (NOx) in the exhaled breath condensates (EBCs) of patients submitted to heart valve surgery and to assess the correlation between NOx levels and postoperative respiratory complications. ⋯ Our results suggest that the postoperative NOx level in the EBC is an early marker of respiratory complications after heart valve surgery. Additional studies using large cohorts are necessary to corroborate our results and to better define the clinical usefulness of assessing NOx in the EBC after cardiac surgery.