Journal of critical care
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Journal of critical care · Aug 2017
Outcomes from extensive training in critical care echocardiography: Identifying the optimal number of practice studies required to achieve competency.
Optimal instruction and assessment of critical care ultrasound (CCUS) skills requires an assessment tool to measure learner competency and changes over time. In this study, a previously published tool was used to monitor the development of critical care echocardiography (CCE) competencies, the attainment of performance plateaus, and the extent to which previous experience influenced learning. ⋯ Supporting earlier results, the RACE scale provided a straightforward means to assess learner performance with minimal requirements for evaluator training. The results of the present study suggest that novices experience the greatest gains in competency during their first twenty practice studies, a threshold which should serve to guide training initiatives.
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Journal of critical care · Aug 2017
Observational StudyMeasurement of physical activity levels in the Intensive Care Unit and functional outcomes: An observational study.
Primary aims were: (1) objectively quantify levels of physical activity with the sensewear armband mini-fly motion sensor (SWA-MF), (2) evaluate the correlation of SWA-MF measurement of active and resting energy expenditure against the ICU Mobility scale (IMS) and indirect calorimetry respectively. ⋯ Participants demonstrated low levels of PA. Motion sensors may be a promising non-invasive measure of energy expenditure and further investigation is warranted.
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Journal of critical care · Aug 2017
Clinical TrialVentilation distribution and lung recruitment with speaking valve use in tracheostomised patient weaning from mechanical ventilation in intensive care.
Speaking valves (SV) are used infrequently in tracheostomised ICU patients due to concerns regarding their putative effect on lung recruitment. A recent study in cardio-thoracic population demonstrated increased end-expiratory lung volumes during and post SV use without examining if the increase in end-expiratory lung impedance (EELI) resulted in alveolar recruitment or potential hyperinflation in discrete loci. ⋯ These findings indicate that hyperinflation did not occur with SV use, which is supported by previously published data on respiratory parameters. These data along with obvious psychological benefits to patients are encouraging towards safe use of SVs in this critically ill cardio-thoracic patient population.
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Journal of critical care · Aug 2017
Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives.
Sepsis can lead to poor outcomes when treatment is delayed or inadequate. The purpose of this study was to evaluate outcomes after initiation of a hospital-wide sepsis alert program. ⋯ A hospital-wide program utilizing electronic recognition and RRT intervention resulted in improved outcomes in patients with sepsis.
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Journal of critical care · Aug 2017
Laboratory and clinical predictors of 30-day survival for patients on Extracorporeal Membrane Oxygenation (ECMO): 8-Year experience at Albert Einstein College of Medicine, Montefiore Medical Center.
Survival of patients on ECMO has remained stable in every population. Laboratory values predictors of survival are required to improve patient care. ⋯ Laboratory markers identified herein may guide the management of patients on ECMO.