Journal of critical care
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Journal of critical care · Dec 2017
Intermediate care to intensive care triage: A quality improvement project to reduce mortality.
Medical patients whose care needs exceed what is feasible on a general ward, but who do not clearly require critical care, may be admitted to an intermediate care unit (IMCU). Some IMCU patients deteriorate and require medical intensive care unit (MICU) admission. In 2012, staff in the Johns Hopkins IMCU expressed concern that patient acuity and the threshold for MICU admission were too high. Further, shared triage decision-making between residents and supervising physicians did not consistently occur. ⋯ Using a structured quality improvement process targeting triage education and increased resident/supervisor communication, we demonstrated reduced mortality among patients transferred from the IMCU to the MICU.
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Journal of critical care · Dec 2017
Predictors of mortality in adults with Sickle cell disease admitted to intensive care unit in Bahrain.
Sickle cell disease (SCD) is one of the most common genetic blood disorders in Bahrain. However, there is a paucity of data regarding the clinical presentation of SCD patients who require ICU admission. This study aimed to describe the epidemiological data of SCD patients admitted to the ICU and to identify predictors of mortality in order to help intensivists identify patients at most risk. ⋯ Acute chest syndrome was the main reason for SCD patients to be admitted to the ICU. Older age, less frequent hospitalization, shorter stays in the ICU, and the need for renal replacement therapy were found to be indicators of high mortality rate SCD patients.
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Journal of critical care · Dec 2017
Stroke volume guided resuscitation in severe sepsis and septic shock improves outcomes.
To determine whether stroke volume (SV) guided fluid resuscitation in patients with severe sepsis and septic shock alters Intensive Care Unit (ICU) fluid balance and secondary outcomes, this retrospective cohort study evaluated consecutive patients admitted to an ICU with the primary diagnosis of severe sepsis or septic shock. Cohorts were based on fluid resuscitation guided by changes in SV or by usual care (UC). The SV group comprised 100 patients, with 91 patients in the UC group. ⋯ The SV group was less likely to require acute hemodialysis (6.25%) compared with the UC group (19.5%) (RR, 0.32; p=0.01). In multivariable analysis, SV was an independent predictor of lower fluid balance, LOS, time on vasopressors, and not needing mechanical ventilation. This study demonstrated that SV guided fluid resuscitation in patients with severe sepsis and septic shock was associated with reduced fluid balance and improved secondary outcomes.
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Journal of critical care · Dec 2017
Sleep study as a diagnostic tool for unexplained respiratory failure in infants hospitalized in the PICU.
The aim of the study was to analyze the diagnostic and therapeutic value of a polygraphy (PG) in infants hospitalized for unexplained respiratory failure or life-threatening events in the PICU. ⋯ PG may assist the diagnosis and guide the management of unexplained respiratory failure or life-threatening events in infants hospitalized in the PICU.
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Journal of critical care · Dec 2017
Case ReportsAdaptive periodic paralysis allows weaning deep sedation overcoming the drowning syndrome in ECMO patients bridged for lung transplantation: A case series.
Sedation in extracorporeal membrane oxygenation (ECMO) is challenging. Patients require deep sedation because of extremely high respiratory rates and increased work of breathing ("Drowning Syndrome") resulting in altered intra-thoracic pressure and reduced pump flow associated with hemodynamic compromise and decreased oxygenation. However, deep sedation impedes essential active rehabilitation with physical therapy. ⋯ Allowing patients to wake up by rapid weaning of continuous narcotics and anesthetic agents using Dexmedetomidine and periodic paralysis to favorably alter hemodynamics is a successful method to wean deep sedation in ECMO.