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
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
Development of an electronic Poor Outcome Screening (ePOS) Score to identify critically ill patients with potential palliative care needs.
To develop and validate an electronic poor outcome screening (ePOS) score to identify critically ill patients with potentially unmet palliative care (PC) needs at 48 hours after ICU admission. ⋯ The ePOS score can easily be implemented in EHR and can be used for automated screening and stratification of ICU patients, pinpointing those in whom a comprehensive PC assessment should be performed. However, it should not replace clinical judgement.
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Journal of critical care · Jun 2022
LetterHigh flow nasal cannula improves breathing efficiency and ventilatory ratio in COPD patients recovering from an exacerbation.
High flow nasal cannula (HFNC) may improve CO2 elimination by washing out CO2 from the upper airways. This study aimed at assessing the effect of HFNC on minute ventilation and ventilatory ratio (VR), a surrogate of dead space, in patients hospitalized for acute hypercapnic COPD exacerbation. ⋯ In patients recovering from acute COPD exacerbation, the use of HFNC reduced RR, minute ventilation, PaCO2 and VR compared to standard oxygen. These changes are consistent with a decrease in physiologic dead space with HFNC.
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Journal of critical care · Jun 2022
The impact of obesity on outcomes of patients admitted to intensive care after cardiac arrest.
Studies examining the association between obesity and mortality in cardiac arrest patients have been conflicting which might either be due to residual confounding, or a reliance on estimating the conditional effects rather than the marginal (causal) effects of obesity. We estimated the conditional and causal effects of obesity on mortality in cardiac arrest patients using the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD). ⋯ After adjustment, there was no association between obesity and outcomes in cardiac arrest patients admitted to ICU.