Journal of critical care
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Journal of critical care · Dec 2014
Benefit of using a "bundled" consent for intensive care unit procedures as part of an early family meeting.
Relatives of patients in the intensive care unit (ICU) are often dissatisfied with family-physician communication. Our prospective preintervention and postintervention study tested the hypothesis that introducing this informed consent process would improve family satisfaction with the ICU process of care. ⋯ A bundled informed consent resulted in higher family satisfaction with the process of care in ICU.
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Journal of critical care · Dec 2014
The Durban World Congress Ethics Round Table Conference Report: I. Differences between withholding and withdrawing life-sustaining treatments.
Withholding life-sustaining treatments (WHLST) and withdrawing life-sustaining treatments (WDLST) occur in most intensive care units (ICUs) around the world to varying degrees. ⋯ Most respondents, practicing intensivists, stated that there is no difference between WHLST and WDLST, supporting most ethicists and professional organizations. A minority of physicians still do not accept their equivalency.
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Journal of critical care · Dec 2014
Is pressure-regulated volume control mode appropriate for severely obstructed patients?
Management of mechanical ventilation in severely obstructed patients remains controversial. Pressure-regulated volume control ventilation (PRVCV) has been suggested to be the best option, as it should ensure a prefixed tidal volume at the lowest peak inspiratory pressure. We sought to determine the accuracy of the delivered volume, compared with the programmed volume, when using PRVCV. ⋯ In high-resistance simulations, the delivered volume was lower when using PCV or PRVCV modes than VCV mode. Pressure control ventilation or PRVCV may fail to provide programmed TV, ultimately leading to hypoventilation of the patient.
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Journal of critical care · Dec 2014
Transcutaneous oxygen tension monitoring in critically ill patients receiving packed red blood cells.
Whether transfusions of packed red blood cells (PRBCs) affect tissue oxygenation in stable critically ill patients is still matter of discussion. The microvascular capacity for tissue oxygenation can be determined noninvasively by measuring transcutaneous oxygen tension (tcpO2). The aim of this study was to assess tissue oxygenation by measuring tcpO2 in stable critically ill patients receiving PRBC transfusions. ⋯ In stable critically ill patients, microvascular tissue oxygenation can be continuously monitored by Clark's tcpO2 electrodes. According to continuous tcpO2 measurements, the microvascular tissue oxygenation is not affected by PRBC transfusions.
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Journal of critical care · Dec 2014
Mean platelet volume is a prognostic factor in patients with acute kidney injury requiring continuous renal replacement therapy.
Platelet size has been demonstrated to reflect platelet activity and to predict poor clinical outcomes in patients with cardiovascular disease. However, the prognostic value of platelet size for mortality has not been studied in patients with acute kidney injury (AKI). ⋯ Mean platelet volume at the time of CRRT initiation may be an inexpensive and useful predictor for 28-day all-cause mortality in patients with AKI requiring CRRT.