Journal of critical care
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Journal of critical care · Dec 2017
Decision support system facilitates rapid decreases in pressure support and appropriate inspiratory muscle workloads in adults with respiratory failure.
A commercially available decision support system (DSS) provides guidance for setting inspiratory pressure support (PS) to maintain work of breathing (WOB/min), breathing frequency (f), and tidal volume (VT) in proper clinical ranges (VentAssist™). If these values are outside the proper clinical range patients may suffer fatigue, atrophy, hypoventilation, hyperventilation, volutrauma, or VT deficiency. The purpose of our study was to evaluate the increase of the percentage of breaths in the targeted clinical ranges when the DSS guidance for setting the PS was followed. ⋯ The DSS is successful at assisting clinicians on how to set PS specific to a patient's individual demands (VT and f) while accounting for their breathing effort (WOB/min). The DSS appears to promote rapid weaning of PS to minimal ventilator settings when appropriate.
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Journal of critical care · Dec 2017
Observational StudyClinical and laboratory predictors of Infectious Complications in patients after Out-of-Hospital Cardiac Arrest.
Identification of clinical and laboratory predictors related to Infectious Complications (ICs) in patients after Out-of-Hospital Cardiac Arrest (OHCA). ⋯ Early initiated antibiotic treatment is overused in patients after OHCA. This practice is associated with necessitating antibiotic change in the majority of patients with IC. Assessment of clinical and laboratory parameters in the first days after OHCA increases the likelihood of appropriate ATB therapy.
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Journal of critical care · Dec 2017
Perioperative prediction of agitated (hyperactive) delirium after cardiac surgery in adults - The development of a practical scorecard.
Delirium is a temporary mental disorder that occurs frequently among hospitalized patients. In this study we sought to develop a user-friendly scorecard based on perioperative features to identify patients at risk of developing agitated delirium after cardiac surgery. ⋯ Using a large cohort of adult patient's undergoing cardiac surgery, a user-friendly scorecard was developed and validated, which will facilitate the implementation of timely interventions to mitigate adverse effects of agitated delirium in this high risk population.
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Journal of critical care · Dec 2017
A modified Delphi process to identify clinical and research priorities in patient and family centred critical care.
To identify elements which enable patient and family centred care (PFCC) in the intensive care unit (ICU) and priorities for PFCC research. ⋯ Stakeholders identified clear and distinct priorities for PFCC in clinical care and research, though there was greater consensus for clinical care.
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Journal of critical care · Dec 2017
Comparative StudyDifference in inspiratory flow between volume and pressure control ventilation in patients with flow dyssynchrony.
Flow dyssynchrony is common during volume control ventilation but minimized during pressure control. Characterizing inspiratory flow during pressure control breaths can inform adjustments of the fixed flow of volume control to address flow dyssynchrony. This study compared inspiratory flow peak and pattern between volume control and adaptive pressure control breaths. ⋯ In patients with flow dyssynchrony during volume control ventilation, adjustment of inspiratory flow pattern should be considered to minimize this dyssynchrony.