Journal of critical care
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Journal of critical care · Dec 2016
Randomized Controlled TrialEvaluation of a critical care outreach service in a middle-income country: A stepped wedge cluster randomized trial and nested qualitative study.
This trial evaluates implementation of critical care outreach in a middle-income country. ⋯ This pragmatic evaluation of critical care outreach in a middle-income country did not show a reduction in mortality or other outcomes.
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Journal of critical care · Dec 2016
Health care-associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes.
Recent data have not demonstrated improved outcomes when guideline-concordant (GC) antibiotics are given to patients with health care-associated pneumonia (HCAP). This study was designed to evaluate the relationship between health outcomes and GC therapy in patients admitted to an intensive care unit (ICU) with HCAP. ⋯ Our data do not demonstrate improved outcomes among ICU patients with HCAP who received GC-HCAP therapy.
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Respiratory failure is among the most common primary causes of or complications of critical illness, and although mechanical ventilation can be lifesaving, it also engenders substantial risk of morbidity and mortality to patients. Three decades of research suggests that the duration of invasive mechanical ventilation can be reduced substantially, reducing morbidity and mortality. Mean duration of ventilation reported in recent international studies suggests a quality chasm in management of this common critical illness. ⋯ To the extent that daily wake-up-and-breathe reduces morbidity, mortality, and length of stay, failure to deploy this strategy is, by definition, malpractice (ie, poor practice). Practical measures are offered to close this quality chasm.
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Journal of critical care · Dec 2016
ReviewAntiepileptic dosing for critically ill adult patients receiving renal replacement therapy.
The aim of this review was to evaluate current literature for dosing recommendations for the use of antiepileptic medications in patients receiving renal replacement therapy (RRT). ⋯ Additional studies are necessary before specific dosing recommendations can be made for most antiepileptic drugs in critically ill patients receiving RRT, specifically with newer agents.
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Journal of critical care · Dec 2016
ICU-RESPECT: An index to assess patient and family experiences of respect in the intensive care unit.
The purpose of the study is to develop a brief index of patient and family experiences of respect in the intensive care unit (ICU). ⋯ The "ICU-RESPECT" index demonstrates high reliability and concurrent validity in ICU patients and families. Future research should validate this index in other ICU settings, assess its predictive validity, and evaluate different methods for maximizing response rate. As hospitals address patient experience more broadly in response to national metrics, the index could identify particular behaviors or ICUs that would benefit from interventions to enhance respectful treatment.