Journal of critical care
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Journal of critical care · Dec 2018
Randomized Controlled Trial Multicenter StudyHigh-flow nasal therapy vs standard oxygen during breaks off noninvasive ventilation for acute respiratory failure: A pilot randomized controlled trial.
To assess the role of high-flow nasal therapy (HFNT) compared to standard oxygen (SO) as complementary therapy to non-invasive ventilation (NIV). ⋯ Compared to SO, HFNT did not reduce time on NIV. However, it was more comfortable and the increase in RR and dyspnea seen with SO did not occur with HFNT. Therefore, HFNT could be a suitable alternative to SO during breaks off NIV.
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Journal of critical care · Dec 2018
ReviewPredictive factors of weaning from mechanical ventilation and extubation outcome: A systematic review.
To identify, describe and discuss the parameters used to predict weaning from mechanical ventilation and extubation outcomes. ⋯ There are several parameters used to predict weaning and extubation outcomes. RSBI was the most frequently studied and seems to be an important measurement tool in deciding whether to wean/extubate a patient. Furthermore, the results demonstrated that weaning and extubation should be guided by several parameters, and not only to respiratory ones.
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Journal of critical care · Dec 2018
ReviewFluid volume, fluid balance and patient outcome in severe sepsis and septic shock: A systematic review.
This systematic review and meta-analysis was conducted to evaluate the mortality risk in severe sepsis and septic shock with a low and high fluid volume/balance. ⋯ High fluid balance from the first 24 h to ICU discharge increases the risk of mortality in severe sepsis and/or septic shock. However, randomized clinical trials should be conducted to resolve the dilemma of fluid resuscitation.
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Journal of critical care · Dec 2018
Abrupt versus gradual cessation of steroids in patients with septic shock.
To determine if a difference in hemodynamic stability would be identified in patients with abrupt withdrawal of steroids compared to patients who underwent a taper. ⋯ The abrupt withdrawal of steroids in patients with resolving septic shock did not impact hemodynamic stability and offers an opportunity to reduce medication burden and reduce adverse drug reactions.
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Journal of critical care · Dec 2018
ReviewPerceptions of medical futility in clinical practice - A qualitative systematic review.
To summarize and compare qualitative studies which explored attitudes of patients, families and healthcare providers towards medical futility. ⋯ This review describes existing opinions about medical futility and demonstrates the multifaceted understanding of medical futility by physicians, caregivers and patients. The difficulties in defining medical futility demonstrate the need for resources to help healthcare providers and patients to deal with decision-making in such situations.