Journal of critical care
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Journal of critical care · Apr 2015
Observational StudyHyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock.
Current guidelines and most trials do not consider elevated lactate (Lac) serum concentrations when grading sepsis severity. We therefore assessed the association of different types of circulatory dysfunction regarding presence of hyperlactatemia and need for vasopressor support with clinical presentation and outcome of sepsis. ⋯ Hyperlactatemia increases risk of death independent of vasopressor need resulting in different phenotypes within the classic categories of severe sepsis and septic shock.
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Journal of critical care · Apr 2015
The Critical Care Communication project: Improving fellows' communication skills.
The aim of this study was to develop an evidence-based communication skills training workshop to improve the communication skills of critical care fellows. ⋯ This 3-day communication skills training program increased critical care fellows' self-reported family meeting communication skills.
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Journal of critical care · Apr 2015
Nursing intensive care skills training: A nurse led, short, structured, and practical training program, developed and tested in a resource-limited setting.
To assess the impact of a nurse-led, short, structured training program for intensive care unit (ICU) nurses in a resource-limited setting. ⋯ Nursing Intensive Care Skills Training was highly rated by participants and was effective in improving the knowledge of the participants. This sustainable short course model may be adaptable to other resource-limited settings.
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Journal of critical care · Apr 2015
High initial tidal volumes in emergency department patients at risk for acute respiratory distress syndrome.
Emergency department (ED) patients are at high risk for the acute respiratory distress syndrome (ARDS). Settings only 1 mL/kg above recommended tidal volumes confers harm for these patients. The purpose of this study was to determine whether ED physicians routinely initiate mechanical ventilation with low tidal volumes in patients at risk for ARDS. ⋯ In an academic, tertiary hospital, newly intubated ED patients in whom ARDS developed within 48 hours after intubation were ventilated with tidal volumes that exceeded recommendations by an average of 1.5 mL/kg.
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Journal of critical care · Apr 2015
Developing a percutaneous dilatational tracheostomy service by medical intensivists: Experience at one academic Institution.
Percutaneous dilatational tracheostomy (PDT) is increasingly becoming the preferred method, compared with open surgical tracheostomy, for patients requiring chronic ventilatory assistance. Little is known regarding the process involved to incorporate PDT as a standard service in the medical intensive care unit. In this report, we describe our experience developing a "PDT service" led by medical intensivists. ⋯ We successfully developed a medical intensivist-driven PDT service, sharing our unique successes and challenges, to facilitate the care of our patients requiring prolonged ventilator support.