Journal of critical care
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Journal of critical care · Oct 2015
Observational StudyOne-year experience with an acute respiratory distress syndrome standard operating procedure on intensive care unit.
Mortality in acute respiratory distress syndrome (ARDS) patients remains unacceptable high, and there is substantial variation in the diagnostic and management strategies used. We recently established a standardized algorithm for the early identification and guideline conform therapy of ARDS on intensive care units (ICUs). We here present the results of a first-year observatory period after implementation of the ARDS bundle on our ICU. ⋯ A standardized ARDS bundle fundamentally increases awareness of this clinical picture on ICU and facilitates application of evidence-based therapies like prone positioning and use of neuromuscular blockers. These data encourage evaluating our ARDS SOP in a prospective trial to identify potential effects on mortality.
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Journal of critical care · Oct 2015
Review Meta AnalysisE7ffect of critical care pharmacist's intervention on medication errors: A systematic review and meta-analysis of observational studies.
Pharmacists are integral members of the multidisciplinary team for critically ill patients. Multiple nonrandomized controlled studies have evaluated the outcomes of pharmacist interventions in the intensive care unit (ICU). This systematic review focuses on controlled clinical trials evaluating the effect of pharmacist intervention on medication errors (MEs) in ICU settings. ⋯ Four studies were included in the meta-analysis. Results suggest that pharmacist intervention has no significant contribution to reducing general MEs, although pharmacist intervention may significantly reduce preventable adverse drug events and prescribing errors. This meta-analysis highlights the need for high-quality studies to examine the effect of the critical care pharmacist.
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Journal of critical care · Oct 2015
Observational StudyProlonged pulmonary support after cardiac surgery: incidence, risk factors and outcomes: a retrospective cohort study.
Post-cardiac surgery pulmonary dysfunction may be underreported. Therefore, we evaluated associated risk factors for prolonged pulmonary support after cardiac surgery. ⋯ We identified risk factors for prolonged mechanical ventilation and supplemental O2 use, described an association with increased adverse outcomes, and determined that persistent pulmonary edema on day 2 was the most likely radiological finding.
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Journal of critical care · Oct 2015
Prospective analysis of cardiac collapsibility of inferior vena cava using ultrasonography.
The inferior vena cava (IVC) diameter and its respiratory change (respiratory variation) reportedly correlate well with the central venous pressure and response to fluid. However, changes in the IVC diameter are related to the cardiac rhythm (cardiac variation), which can be useful as an indicator for intravascular volume but can affect respiratory variation. We conducted a prospective analysis of this cardiac variation in adult emergency department patients. ⋯ The IVC cardiac variation affects our interpretation of ultrasonography IVC imaging. The IVC cardiac variation provides several advantages over other parameters of intravascular volume. Therefore, it can be a novel tool to assess the intravascular volume of the patients.