Journal of critical care
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Journal of critical care · Oct 2020
Critical care guidelines on pain, agitation and delirium management: Which one to use? A systematic literature search and quality appraisal with AGREE II.
Clinical practice guidelines (CPGs) facilitate the provision of standardized, high-quality intensive care medicine. For the management of pain, agitation and delirium, several coexisting CPGs have been published. This study aims at the appraisal of CPGs on pain, agitation and delirium management in the intensive care unit to (a) identify high quality guidelines appropriate for clinical use and (b) identify potential areas for future improvement. ⋯ Three of the eight reviewed guidelines exceeded the quality threshold in all domains, while the overall guideline quality was also very high. Focusing on guideline applicability and identifying strategies to facilitate implementation can improve future CPGs.
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Journal of critical care · Oct 2020
What can be learned from crude intensive care unit mortality? Methodological implications.
Demonstrate the practical range of information that can be obtained about ICU mortality/survival from limited administrative data. ⋯ Simple calculations using the few variables found in administrative database enhanced information provided by the crude mortality rate and demonstrated that temporal patterns of mortality change as stay lengthens. These results highlight the limitations of just using overall crude mortality rates.
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Journal of critical care · Oct 2020
Observational StudyRisk of incident bleeding after acute kidney injury: A retrospective cohort study.
End-stage kidney disease (ESKD) causes bleeding diathesis; however, whether these findings are extrapolable to acute kidney injury (AKI) remains uncertain. We assessed whether AKI is associated with an increased risk of bleeding. ⋯ AKI-requiring dialysis was associated with incident bleeding, independent of anticoagulant administration. Studies are needed to better understand how AKI affects coagulation and clinical outcomes.
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A recent meta-analysis by Munshi et al. (Lancet Respiratory Medicine, 2019) claimed mortality treatment efficacy for extra corporeal membrane oxygenation (ECMO) in the acute respitratory syndrome (ARDS) despite very low meta-analytic study numbers (n = 2 (RCTs), risk-ratio (RR) 0·73 (95%CI: 0·58-0·92); n = 5 (2 RCT, 3 observational), RR 0·69 (95%CI: 0·50-0·95)). We explore this efficacy claim by a comprehensive re-analysis of the data. ⋯ Having canvassed the conduct of both meta-analyses presented by Munshi et al. and proffered alternative methods, we find no certainty regarding the efficacy of ECMO in ARDS.
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Journal of critical care · Oct 2020
Narrative critical care: A literary analysis of first-person critical illness pathographies.
Life-threatening illness can be devastating for patients as they experience shifting levels of consciousness, recurrent delirium, and repeated setbacks. Narrative Medicine and its sub-discipline Narrative Critical Care increase healthcare professionals' understanding of the patient perspective, and interpretation of their stories is a means to improving practice. ⋯ We uncovered commonalities and differences in storied accounts of critical illness and survival. New insights might enable healthcare professionals to personalize patient care. More consistency is needed during transitions and rehabilitation of intensive care survivors.