Journal of critical care
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Journal of critical care · Feb 2016
Finding the red flags: Swallowing difficulties after cardiac surgery in patients with prolonged intubation.
This retrospective audit set out to identify referral rates, swallowing characteristics, and risk factors for dysphagia and silent aspiration in at-risk patients after cardiac surgery. Dysphagia and silent aspiration are associated with poorer outcomes post cardiac surgery. ⋯ Patients identified with dysphagia after cardiac surgery had a high incidence of silent aspiration and increased risk of pneumonia. However, referral rates were low in this at-risk patient group. Early identification and ongoing assessment and appropriate management of dysphagic patients by a speech-language pathologist are strongly recommended.
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Journal of critical care · Feb 2016
Observational StudyPostoperative sepsis in cancer patients undergoing major elective digestive surgery is associated with increased long-term mortality.
Major postoperative events (acute respiratory failure, sepsis, and surgical complications) are frequent early after elective gastroesophageal and pancreatic surgery. It is unclear whether these complications impact equally on long-term outcome. ⋯ Postoperative sepsis was the only major postoperative event associated with long-term mortality. Postoperative sepsis may reflect a deep impairment of immune response, which is potentially associated with cancer recurrence and mortality.
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To explore the hypothesis that early ventilation strategies influence clinical outcomes in lung transplantation, we have examined our routine ventilation practices in terms of tidal volumes (Vt) and inflation pressures. ⋯ Low Vt ventilation has not been fully adopted in our practice. Ventilation with higher inflation pressures, but not Vt, was significantly associated with poorer outcomes after lung transplantation.
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Journal of critical care · Feb 2016
Moral distress in intensive care unit professionals is associated with profession, age, and years of experience.
To determine which demographic characteristics are associated with moral distress in intensive care unit (ICU) professionals. ⋯ Moral distress is higher in ICU nurses and other non-physician professionals than in physicians, is lower with older age for other non-physician professionals but greater with more years of experience in nurses, and is associated with tendency to leave the job.
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Journal of critical care · Feb 2016
Observational StudyAcute respiratory distress syndrome: Predictors of noninvasive ventilation failure and intensive care unit mortality in clinical practice.
Noninvasive ventilation (NIV) is used as an initial ventilatory support in acute respiratory distress syndrome (ARDS), but its utility is unclear, and persistence in those who do not improve may delay intubation and lead to adverse outcomes. Hence, it becomes imperative to have a clear understanding of selecting patients who will benefit from this modality. ⋯ Noninvasive ventilation maybe useful in selected patients with mild ARDS but should be used with great caution in moderate and severe ARDS, as failure risk is high. In addition, low PaO2/FIO2 and shock are associated with NIV failure. Acute Physiology and Chronic Health Evaluation II score, shock, low PaO2/FIO2, and ARDS severity are associated with increased mortality.