Journal of critical care
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Journal of critical care · Apr 2019
ReviewDecision-making in ICU - A systematic review of factors considered important by ICU clinician decision makers with regard to ICU triage decisions.
The ICU is a scarce resource within a high-stress, high-stakes, time-sensitive environment where critically ill patients with life-threatening conditions receive expensive life-sustaining care under the guidance of expert qualified personnel. The implications of decisions such as suitability for admission into ICU are potentially dire and difficult. ⋯ The complex and dynamic ICU triage decision is affected by numerous interacting factors. The literature provides some indication of these factors, but fail to show complexities and interactions between them. A decision tree is proposed. Further research should include a reflection on how decisions for admission to ICU are made, such that a better understanding of these processes can be achieved allowing for improved individual and group consistency.
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Journal of critical care · Apr 2019
Non-clinical delays in transfer out of the surgical ICU are associated with increased hospital length of stay and delayed progress of care.
The impact of non-clinical transfer delay (TD) from the ICU to a general care unit on the progress of the patient's care is unknown. We measured the association between TD and: (1) the patient's subsequent hospital length of stay (LOS); (2) the timing of care decisions that would advance patient care. ⋯ TD is associated with longer LOS and delays in milestone clinical decisions that progress care. Eliminating delays in milestones could mitigate TD's impact on LOS.
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In critical illness, the relation between the macrocirculation, microcirculation and organ dysfunction, such as acute kidney injury (AKI), is complex. This study aimed at identifying predictors for AKI in patients with cardiogenic shock. ⋯ In this population of patients with cardiogenic shock, CVP was associated with the development of AKI.
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Journal of critical care · Apr 2019
Review Meta Analysis Comparative StudyCrystalloids vs. colloids for fluid resuscitation in the Intensive Care Unit: A systematic review and meta-analysis.
Guidelines recommend crystalloids for fluid resuscitation in sepsis/shock and switching to albumin in cases where crystalloids are insufficient. We evaluated hemodynamic response to crystalloids/colloids in critically ill adults. ⋯ Crystalloids were less efficient than colloids at stabilizing resuscitation endpoints; guidance on when to switch is urgently required.
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Journal of critical care · Apr 2019
ReviewInterventions for the management and prevention of sarcopenia in the critically ill: A systematic review.
In the critically ill, sarcopenia is associated with a variety of adverse outcomes however there is no consensus regarding its management. This study aimed to systematically review the evidence for interventions for the management and prevention of sarcopenia in critically ill patients. ⋯ NMES and exercise-based interventions may preserve muscle mass and function in patients with critical illness. There is a lack of consistency seen in the effects of these interventions. Further, large, high quality RCTs are required.