Journal of critical care
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Journal of critical care · Jun 2022
Design thinking to improve healthcare delivery in the intensive care unit: Promise, pitfalls, and lessons learned.
Design thinking is a problem-solving approach characterized by the empathetic lens through which designers integrate perspectives of end-users and key stakeholders throughout the entire process of developing solutions. This approach is rooted in diverse fields including engineering, computer science, psychology, and business and is increasingly widespread in healthcare. Herein, we describe the promise of design thinking to help solve intractable problems in healthcare delivery, including those within the complex social and technical intensive care unit system. ⋯ However, given the high stakes of design failure in healthcare, we also discuss the limitations of this approach and the potential consequences of inadequate application. Finally, we suggest a pathway forward that combines the philosophy and tools of design thinking with existing methods within healthcare delivery science, such as qualitative research, quality improvement methods, and implementation science. Ultimately, we argue that design thinking is a valuable approach to guide designers, clinicians, researchers, and administrators towards a more genuine understanding of the healthcare experience, through the lens of patients, their families, and frontline clinicians.
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Journal of critical care · Jun 2022
Randomized Controlled TrialThe effect of prostacyclin infusion on markers of endothelial activation and damage in mechanically ventilated patients with SARS-CoV-2 infection.
In a pilot study, we found a significant reduction in mean daily sequential organ failure assessment score in mechanically ventilated patients with COVID-19 who received prostacyclin, compared to placebo. We here investigate the effect on biomarkers of endothelial activation and damage. ⋯ Prostacyclin infusion, compared to placebo, resulted in a measurable decrease in endothelial glycocalyx shedding (syndecan-1) at 24 h, suggesting a protective effect on the endothelium, which may be related to the observed reduction in organ failure.
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Journal of critical care · Jun 2022
Multicenter StudyPerformance of renal Doppler to predict the occurrence of acute kidney injury in patients without acute kidney injury at admission.
This study aimed at evaluating the performance of Doppler-based resistive index (RI) and semi-quantitative evaluation of renal perfusion using color-Doppler (SQP) to predict de novo AKI in the subgroup of critically ill patients without AKI at admission. ⋯ These results confirm the poor performance of Doppler-based indices in predicting renal prognosis of ICU patients.
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Journal of critical care · Jun 2022
REDUCE - Indication catalogue based ordering of chest radiographs in intensive care units.
To advance a transition towards an indication-based chest radiograph (CXR) ordering in intensive care units (ICUs) without compromising patient safety. ⋯ A substantial reduction of the number of CXRs on ICUs was feasible and safe using an indication catalogue thereby improving resource management.
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Journal of critical care · Jun 2022
Observational StudyFeasibility of non-invasive respiratory drive and breathing pattern evaluation using CPAP in COVID-19 patients.
Increased respiratory drive and respiratory effort are major features of acute hypoxemic respiratory failure (AHRF) and might help to predict the need for intubation. We aimed to explore the feasibility of a non-invasive respiratory drive evaluation and describe how these parameters may help to predict the need for intubation. ⋯ Non-invasive assessment of respiratory drive was feasible in patients with AHRF and showed an increased P0.1, although it was not predictive of intubation.