Journal of critical care
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Journal of critical care · Oct 2018
Decision-making skills improve with critical care training: Using simulation to measure progress.
Health care professionals are expected to acquire decision-making skills during their training, but few methods are available to assess progress in acquiring these essential skills. The purpose of this study was to determine whether a simulation methodology could be used to assess whether decision-making skills improve during critical care training. ⋯ These findings provide evidence to support the validity of a simulation-based method to assess progress in decision-making skills. A simulation methodology could be used to establish a performance standard that determined a provider's ability to make independent decisions.
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Journal of critical care · Oct 2018
Albumin, a marker for post-operative myocardial damage in cardiac surgery.
Low serum albumin (SA) is a prognostic factor for poor outcome after cardiac surgery. The aim of this study was to estimate the association between pre-operative SA, early post-operative SA and postoperative myocardial injury. ⋯ Post-operative albumin levels were significantly correlated with the amount of postoperative myocardial damage in patients undergoing cardiac surgery independent of typical confounders.
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Journal of critical care · Oct 2018
Echocardiographic left ventricular diastolic dysfunction predicts hospital mortality after out-of-hospital cardiac arrest.
To determine whether systolic or diastolic dysfunction on transthoracic echocardiogram (TTE) predicts mortality after out-of-hospital cardiac arrest (OHCA). ⋯ Diastolic dysfunction (higher medial mitral E/e' ratio) on TTE independently predicted mortality after OHCA; systolic dysfunction and TTE hemodynamic parameters did not. This reflects a novel use of Doppler TTE to predict outcomes after OHCA.
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Journal of critical care · Oct 2018
Acute respiratory distress syndrome without identifiable risk factors: A secondary analysis of the ARDS network trials.
We examined whether patients with acute respiratory distress syndrome (ARDS) lacking risk factors are enrolled in therapeutic trials and assessed their clinical characteristics and outcomes. ⋯ Patients with ARDS without identifiable risk factors are enrolled in therapeutic trials and may have better outcomes, including a higher proportion of rapidly resolving ARDS, than those with risk factors.
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Journal of critical care · Oct 2018
Case ReportsA novel technique to establish hemodynamic monitoring in patients supported with extracorporeal life support systems (ECLS) for cardiopulmonary resuscitation (ECPR).
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to support conventional unsuccessful resuscitation and it is mandatory to rapidly initiate invasive hemodynamic monitoring, as soon as ECPR therapy is commenced. Commonly, this is achieved by establishing an additional arterial line via the right radial artery for invasive blood pressure measurement, but this can be challenging and risky on the one hand and might lead to erroneous measurements on the other hand. Therefore, a faster, easier, safer and more valid method for hemodynamic monitoring is pressingly needed. ⋯ Invasive hemodynamic monitoring in critically ill patients with VA-ECMO support is easily and rapidly achievable by introducing a pigtail catheter through a modified arterial ECMO cannula. Validation of this method in larger clinical trials is warranted.