Journal of critical care
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Journal of critical care · Feb 2018
Effects of staff training and electronic event monitoring on long-term adherence to lung-protective ventilation recommendations.
To investigate long-term effects of staff training and electronic clinical decision support (CDS) on adherence to lung-protective ventilation recommendations. ⋯ Staff training effectively improves adherence to lung-protective ventilation strategies. The observed CDS effect seemed less pronounced, although it can easily be adapted to new recommendations. Both interventions, which futures studies could deploy in combination, promise to improve the precision of mechanical ventilation.
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Journal of critical care · Feb 2018
Randomized Controlled Trial Multicenter Study Comparative StudyEnteral nutrition as stress ulcer prophylaxis in critically ill patients: A randomized controlled exploratory study.
We investigated whether early enteral nutrition alone may be sufficient prophylaxis against stress-related gastrointestinal (GI) bleeding in mechanically ventilated patients. ⋯ We found no benefit when pantoprazole is added to early enteral nutrition in mechanically ventilated critically ill patients. The routine prescription of acid-suppressive therapy in critically ill patients who tolerate early enteral nutrition warrants further evaluation.
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Journal of critical care · Feb 2018
ReviewMajor publications in the critical care pharmacotherapy literature: January-December 2016.
To summarize select critical care pharmacotherapy guidelines and studies published in 2016. ⋯ The review provides a synopsis of select pharmacotherapy publications in 2016 applicable to clinical practice.
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Journal of critical care · Feb 2018
Observational StudyBalanced haemostasis with both hypo- and hyper-coagulable features in critically ill patients with acute-on-chronic-liver failure.
Cirrhotic patients have complex haemostatic abnormalities. Current evidence suggests stable cirrhotic (SC) patients have a "re-balanced" haemostatic state. However, limited data exists in acute decompensated (AD) or acute on chronic liver failure (ACLF) patients. ⋯ Our cohorts, despite significant differences in haemostatic parameters, displayed intact thrombin generation but progressive hypo-functional clot stability and potentially but not universal hyper-functional haemostasis.
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Journal of critical care · Feb 2018
Clinical management of pressure control ventilation: An algorithmic method of patient ventilatory management to address "forgotten but important variables".
Pressure controlled ventilation is a common mode of ventilation used to manage both adult and pediatric populations. However, there is very little evidence that distinguishes the efficacy of pressure controlled ventilation over that of volume controlled ventilation in the adult population. This gap in the literature may be due to the absence of a consistent and systematic algorithm for managing pressure controlled ventilation. ⋯ This algorithmic approach highlights the need for clinicians to have a comprehensive conceptual understanding of mechanical ventilation, pulmonary physiology, and interpretation of ventilator graphics in order to best care for patients receiving pressure controlled ventilation. The objective of identifying a systematic approach to managing pressure controlled ventilation is to provide a more generalizable and equitable approach to management of the ICU patient. Ideally, a consistent approach to managing pressure controlled ventilation in the adult population will glean more reliable information regarding actual patient outcomes, as well as the efficacy of pressure controlled ventilation when compared to volume controlled ventilation.