Journal of critical care
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Journal of critical care · Oct 2019
Adhering to the procalcitonin algorithm allows antibiotic therapy to be shortened in patients with ventilator-associated pneumonia.
Ventilator-associated pneumonia (VAP) increases exposure to antibiotics. Physicians are however reluctant to shorten treatment, arguing this could lead to failures and worse outcome. Monitoring procalcitonin (PCT) has proven effective for decreasing exposure to antibiotics in randomized controlled trials, but additional "real-life" studies are needed. ⋯ PCT-guided ABT adherence appears safe for patients with VAP and is likely to reduce exposure to antibiotics.
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Journal of critical care · Oct 2019
Assessment of need for lower level acuity critical care services at a tertiary acute care hospital in Canada: A prospective cohort study.
Critical care beds are commonly described in three levels (highest level 3, lowest level 1). We aimed to describe the actual level of care for patients assigned to level 2 in a tertiary hospital with inadequate level 1 bed capacity. ⋯ In a single centre, 14.9% of level 2 patients could have been cared for in a lower acuity bed for the entirety of their ICU stay. We believe this methodology is reproducible and can help resource allocation with regard to the high demand for critical care beds.
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Journal of critical care · Oct 2019
Technology-mediated macrocognition: Investigating how physicians, nurses, and respiratory therapists make critical decisions.
Although intensive care clinicians are expected to make data-driven critical decisions using the technologies available to them, the effect of those technologies on decision-making are not well understood. Using the macrocognitive framework, we studied critical decision-making and technology use to understand how different specialists within teams make decisions and guide the development of decision-making support technologies. ⋯ This exploratory study provides much needed details about the different ways in which specialists use technologies to support decision-making tasks, particularly those involving sensemaking, which are essential to the design and development of decision-support technologies.
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Journal of critical care · Oct 2019
Observational StudyEffects of short-term hyperoxia on sytemic hemodynamics, oxygen transport, and microcirculation: An observational study in patients with septic shock and healthy volunteers.
To characterize the microvascular effects of a brief period of hyperoxia, in patients with septic shock and in healthy volunteers. ⋯ Short-term hyperoxia induced systemic cardiovascular changes but was not associated with noticeable derangement in sublingual microcirculation and skin perfusion. Nevertheless, longer exposures to hyperoxia might have produced different results.
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Journal of critical care · Oct 2019
Review Meta AnalysisDiarrhea and patient outcomes in the intensive care unit: Systematic review and meta-analysis.
We aimed to determine whether diarrhea experienced by patients in the intensive care unit (ICU) is related to their clinical outcomes. ⋯ The diarrhea experienced by patients may be associated with higher mortality and prolonged length of stay in the ICU and hospital.