Journal of critical care
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Journal of critical care · Jun 2019
Admission characteristics predictive of in-hospital death from hospital-acquired sepsis: A comparison to community-acquired sepsis.
Healthcare associated (HA) sepsis is associated with increased resource utilization and mortality compared with community acquired (CA) sepsis. The purpose of this study was to identify independent predictors of in-hospital mortality from HA-sepsis. ⋯ Liver disease and CHF were independent predictors of in-hospital mortality in HA-sepsis. HA-sepsis patients had increased prevalence of previous stroke, myocardial infarction, and liver disease.
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Journal of critical care · Jun 2019
Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation.
Poor coordination may impede delivery of the Awakening, Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle. Developing a shared mental model (SMM), where all team members are on the same page, may support coordination. ⋯ Increasing awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles like ABCDE.
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Journal of critical care · Jun 2019
Case ReportsInhaled nitric oxide prevents systemic and pulmonary vasoconstriction due to hemoglobin-based oxygen carrier infusion: A case report.
Hemoglobin-based oxygen carriers (HBOCs) are used in extreme circumstances to increase hemoglobin concentration and improve oxygen delivery when allogenic red blood cell transfusions are contraindicated or not immediately available. However, HBOC-induced severe pulmonary and systemic vasoconstriction due to peripheral nitric oxide (NO) scavenging has stalled its implementation in clinical practice. We present a case of an 87 year-old patient with acute life-threatening anemia who received HBOC while breathing NO gas. This case shows that inhaled NO allows for the safe use of HBOC infusion by preventing HBOC-induced pulmonary and systemic vasoconstriction.
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Journal of critical care · Jun 2019
The evolution of diaphragm activity and function determined by ultrasound during spontaneous breathing trials.
Rapid shallow breathing index (RSBI) is a commonly used index for predicting the outcome of spontaneous breathing trial (SBT). Ultrasound is a non-invasive technique for assessing diaphragm activity and function. This study aimed to investigate changes in diaphragm activity during SBT, and to compare diaphragm function between patients with and without SBT success. ⋯ Patient inspiratory efforts significantly increased during SBT. TFditidal measured by diaphragm ultrasound could not distinguish between patients with SBT success and failure. RSBI was significantly higher during SBT in patients with SBT failure.
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Journal of critical care · Jun 2019
The perils of medico-legal advocacy in ICU conflicts at the end of life: A qualitative study of what happens when advocacy and best interests collide.
An unexplored aspect of conflicts and conflict resolution in the ICU at EOL is the role of advocacy in both medicine and law.