Journal of critical care
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Journal of critical care · Oct 2017
Association between advanced practice nursing and 30-day mortality in mechanically ventilated critically ill patients: A retrospective cohort study.
Little is known about the association between advanced practice nursing and mortality. The aim of this study was to evaluate whether the presence of advanced practice nurses (APN), that is, certified nurse (CN) and certified nurse specialist (CNS) in intensive care, is associated with 30-day mortality for mechanically ventilated critically ill patients. ⋯ Our findings show that APNs may play an important role in improving patient outcome in the adult ICU.
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Journal of critical care · Oct 2017
Mechanical ventilation weaning protocol improves medical adherence and results.
Implementation of a weaning protocol is related to better patient prognosis. However, new approaches may take several years to become the standard of care in daily practice. We conducted a prospective cohort study to investigate the effectiveness of a multifaceted strategy to implement a protocol to wean patients from mechanical ventilation (MV) and to evaluate the weaning success rate as well as practitioner adherence to the protocol. ⋯ A multifaceted strategy consisting of continuing education and regular feedback can increase physician adherence to a weaning protocol for mechanical ventilation.
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Journal of critical care · Oct 2017
Experience using high-dose glucose-insulin-potassium (GIK) in critically ill patients.
To audit the use of GIK in terms of safety, haemodynamic effects, and impact on catecholamine dosage. ⋯ High-dose GIK can be safely used in critically ill patients, though blood glucose and potassium levels must be monitored frequently. GIK was associated with improved CI and blood lactate levels. Impact on survival requires prospective evaluation.
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Journal of critical care · Oct 2017
A retrospective analysis of the effectiveness of antipsychotics in the treatment of ICU delirium.
Conflicting data exists on the efficacy of antipsychotics for treatment of intensive care unit (ICU) delirium. The purpose of this study was to compare time to delirium resolution for ICU patients who were managed with and without antipsychotics. ⋯ While the treatment of delirium with antipsychotics remains common, antipsychotics were not associated with a shorter time to resolution of delirium.
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Journal of critical care · Oct 2017
LetterA roadmap for acute care training of frontline Healthcare workers in LMICs.
This 10-step roadmap outlines explicit procedures for developing, implementing and evaluating short focused training programs for acute care in low and middle income countries (LMICs). A roadmap is necessary to develop resilient training programs that achieve equivalent outcomes despite regional variability in human capacity and infrastructure. Programs based on the roadmap should address shortfalls in human capacity and access to care in the short term and establish the ground work for health systems strengthening in the long term. ⋯ Core features are integration of frontline trainees with the referral system while promoting research, quality improvement and evaluation from the bottom-up. Training programs must be evidence based, developed along action timelines and use adaptive training methods. A systems approach is essential because training programs that take cognizance of all factors that influence health care delivery have the potential to produce health systems strengthening (HSS).