Journal of critical care
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Journal of critical care · Oct 2017
Impact of physician education and availability of parameters regarding esophageal pressure and transpulmonary pressure on clinical decisions involving ventilator management.
This study investigated the effects of physician education and the availability of Peso and PL data on physicians' decisions regarding ventilator management during specific simulated clinical conditions. ⋯ Providing education and data for Peso and PL had a significant effect on physician decisions regarding ventilator management in simulated cases. The use of case scenario-based education with simulator devices for physicians may hasten worldwide understanding and clinical application of Peso and PL.
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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).
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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
Serum lactate dehydrogenase is predictive of persistent organ failure in acute pancreatitis.
Elevated serum lactate dehydrogenase (LDH) has been reported in a serious of clinical diseases. However, the relationship between LDH and the incidence of persistent organ failure (POF) in acute pancreatitis (AP) has not been characterized. ⋯ Our results indicate that serum LDH on admission is independently associated with POF in AP and may serve as a potential prognostic factor.
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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.