Journal of critical care
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Journal of critical care · Aug 2015
Observational StudyRisk factors for fluconazole-resistant invasive candidiasis in intensive care unit patients: An analysis from the China Survey of Candidiasis study.
To assess the risk factors for invasive Candida infection (ICI) caused by fluconazole-resistant (Flu-R) Candida species in intensive care unit (ICU) patients. ⋯ As many as 41% of ICI patients were infected with Flu-R Candida, and the main risk factor was longer ICU stay before onset of ICI, implying that caution should be exercised when treating patients who have been long stayed in ICU with fluconazole as the first-line drug before testing isolates for drug sensitivity.
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Journal of critical care · Aug 2015
Implementing and sustaining an early rehabilitation program in a medical intensive care unit: A qualitative analysis.
Early rehabilitation programs in a medical intensive care unit can improve patient outcomes, but clinicians face barriers in implementing and sustaining such programs. We sought to describe a multidisciplinary team perspective regarding how to implement and sustain a successful early rehabilitation program. ⋯ This qualitative study of a successful early rehabilitation program highlights the importance of assessing and engaging a multidisciplinary team before implementation and the positive outcomes of early rehabilitation on staff by improving job satisfaction and changing the culture of a hospital unit.
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Journal of critical care · Aug 2015
Review Case ReportsApnea testing on extracorporeal membrane oxygenation: Case report and literature review.
Extracorporeal membrane oxygenation (ECMO) is used to resuscitate patients with cardiovascular collapse or refractory respiratory failure. Determination of death by neurologic criteria requires the performance of an apnea test. Few data exist describing performance of an apnea test in this setting. Understanding of ECMO physiology and mechanics is critical in the efficient and proper delivery of apnea testing. ⋯ According to current guidelines, apnea testing has to be performed after prerequisites have been met and in a fashion where hypercapnia is achieved in the face of stable oxygenation and hemodynamics. Performance of the test during ECMO is feasible.
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Journal of critical care · Aug 2015
ReviewEarly mobilization in the critical care unit: A review of adult and pediatric literature.
Early mobilization of critically ill patients is beneficial, suggesting that it should be incorporated into daily clinical practice. Early passive, active, and combined progressive mobilizations can be safely initiated in intensive care units (ICUs). Adult patients receiving early mobilization have fewer ventilator-dependent days, shorter ICU and hospital stays, and better functional outcomes. ⋯ Contraindications and perceived barriers to early mobilization, including cost and health care provider views, are identified. Methods of overcoming barriers to early mobilization and enhancing sustainability of mobilization programs are discussed. Optimization of patient outcomes will require further studies on mobilization timing and intensity, particularly within specific ICU populations.
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Journal of critical care · Aug 2015
ReviewPharmacologic prevention and treatment of delirium in intensive care patients: A systematic review.
The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients. ⋯ The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.