Journal of critical care
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Journal of critical care · Dec 2022
Physicians' attitudes and perceptions of neuromuscular blocker infusions in ARDS.
The perceptions and practices of ICU physicians regarding initiating neuromuscular blocker infusions (NMBI) in acute respiratory distress syndrome (ARDS) may not be evidence-based amidst the surge of severe ARDS during the SARS-CoV-2 pandemic and new practice guidelines. We identified ICU physicians' perspectives and practices regarding NMBI use in adults with moderate-severe ARDS. ⋯ Most intensivists agreed NMBI in ARDS should be reserved until after a deep sedation trial. Stopping criteria remain poorly defined. Unique considerations exist regarding the role of paralysis in COVID-19+ ARDS.
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Journal of critical care · Dec 2022
Association between early, small creatinine elevation and severe acute kidney injury in critically ill adult patients.
Early prediction of AKI is crucial for critically ill patients. We investigated the association between small increase in creatinine and subsequent severe AKI in ICU patients. ⋯ Small creatinine elevation within the first 48 h of ICU admission was strongly associated with the AKI, kidney replacement therapy, and death. This association was more prominent in patients with normal baseline creatinine.
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Journal of critical care · Dec 2022
Perfusion-based deresuscitation during continuous renal replacement therapy: A before-after pilot study (The early dry Cohort).
Active fluid removal has been suggested to improve prognosis following the resolution of acute circulatory failure. We have implemented a routine care protocol to guide fluid removal during continuous renal replacement therapy (CRRT). We designed a before-after pilot study to evaluate the impact of this deresuscitation strategy on the fluid balance. ⋯ Our perfusion-based deresuscitation protocol achieved a greater negative cumulative fluid balance compared to standard practices and was hemodynamically well tolerated.
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Journal of critical care · Dec 2022
Risk factors for mortality in ICU patients in 10 middle eastern countries: The role of healthcare-associated infections.
The International Nosocomial Infection Control Consortium (INICC) found a high mortality rate in ICUs of the Middle East (ME). Our goal was to identify mortality risk factor (RF) in ICUs of the ME. ⋯ Some identified RF are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; LOS, CL-use, MV-use, CLABSI, VAP. So, to lower the mortality risk in ICUs, we recommend focusing on strategies to shorten the LOS, reduce CL and MV-utilization, and use evidence-based recommendations to prevent CLABSI and VAP.