Journal of critical care
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Journal of critical care · Jun 2014
Influenza A (H1N1) vs non-H1N1 ARDS: Analysis of clinical course.
The purpose of the study is to compare H1N1-induced acute respiratory distress syndrome (ARDS) with ARDS due to other causes of severe community-acquired pneumonia focusing on pulmonary function. ⋯ Clinical course of H1N1-ARDS is substantially different from non-H1N1-ARDS. Affected patients may require extensive therapy including extracorporeal lung support in ARDS referral centers.
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Journal of critical care · Jun 2014
ReviewImproving patient care through the prism of psychology: Application of Maslow's hierarchy to sedation, delirium, and early mobility in the intensive care unit.
The intensive care unit (ICU) is not only a place where lives are saved; it is also a site of harm and iatrogenic injury for millions of people treated in this setting globally every year. Increasingly, hospitals admit only the sickest patients, and although the overall number of hospital beds remains stable in the United States, the percentage of that total devoted to ICU beds is rising. These 2 realities engender a demographic imperative to address patient safety in the critical care setting. ⋯ Although there is currently much research and quality improvement in this area, most of what we know from these data and published guidelines has not become reality in the day-to-day management of ICU patients. This article is not intended to provide a comprehensive review of the literature but rather a framework to rethink our currently outdated culture of critical care by employing Maslow's hierarchy of needs, along with a few novel analogies. Application of Maslow's hierarchy will help propel health care professionals toward comprehensive care of the whole person not merely for survival but toward restoration of pre-illness function of mind, body, and spirit.
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Journal of critical care · Jun 2014
Multicenter Study Observational StudyDelirium and coma evaluated in mechanically ventilated patients in the intensive care unit in Japan: A multi-institutional prospective observational study.
The object of this study is to evaluate the prevalence and effects of delirium on 28-day mortality in critically ill patients on mechanical ventilation in Japan. ⋯ Further study is needed to investigate the discrepancy between these and previous data.
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Journal of critical care · Jun 2014
Randomized Controlled TrialCycling-off modes during pressure support ventilation: Effects on breathing pattern, patient effort, and comfort.
Expiratory asynchrony during pressure support ventilation (PSV) has been recognized as a cause of patient discomfort, increased workload, and impaired weaning process. We evaluated breathing pattern, patient comfort, and patient effort during PSV comparing 2 flow termination criteria: fixed at 5% of peak inspiratory flow vs automatic, real-time, breath-by-breath adjustment within the range of 5% to 55%. ⋯ When compared with a fixed termination criterion, the use of a variable, real-time-adjusted termination criterion improved some indices of patient-ventilator synchrony, producing better breathing pattern, less discomfort, and slightly lower patient effort during PSV.
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Journal of critical care · Jun 2014
The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors.
To determine whether frailty can be measured within 4 days prior to hospital discharge in older intensive care unit (ICU) survivors of respiratory failure and whether it is associated with post-discharge disability and mortality. ⋯ Frailty can be measured in older ICU survivors near hospital discharge and is associated with 6-month mortality in unadjusted analysis. Larger studies to determine if frailty independently predicts outcomes are warranted.