Journal of critical care
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Journal of critical care · Jun 2023
Observational StudyReverse triggering neural network and rules-based automated detection in acute respiratory distress syndrome.
Dyssynchrony may cause lung injury and is associated with worse outcomes in mechanically ventilated patients. Reverse triggering (RT) is a common type of dyssynchrony presenting with several phenotypes which may directly cause lung injury and be difficult to identify. Due to these challenges, automated software to assist in identification is needed. ⋯ Automated detection of RT demonstrated good performance, with the potential application of these programs for research and clinical care.
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Journal of critical care · Jun 2023
Assessing a standardized decision-making algorithm for blood culture collection in the intensive care unit.
Blood cultures are commonly ordered for patients with low risk of bacteremia. Indications for obtaining blood cultures are often broad and ill defined, and decision algorithms for appropriate blood cultures have not been comprehensively evaluated in critically-ill populations. ⋯ In a cohort of critically-ill patients, inappropriate blood cultures were common. The indications for blood cultures are often not evidence-based, and evidence-based algorithms to guide the collection of blood cultures may offer a way to decrease inappropriate culture orders.
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We developed and validated two parsimonious algorithms to predict the time of diagnosis of any stage of acute kidney injury (any-AKI) or moderate-to-severe AKI in clinically actionable prediction windows. ⋯ The two AKI prediction models have good discriminative performance using common features, which can aid in accurately and informatively monitoring AKI risk in ICU patients.
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Journal of critical care · Jun 2023
Stakeholder engagement as a strategy to enhance palliative care involvement in intensive care units: A theory of change approach.
Adult patients admitted to intensive care units in the terminal phase experience high symptom burden, increased costs, and diminished quality of dying. There is limited literature on palliative care engagement in ICU, especially in lower-middle-income countries. This study explores a strategy to enhance palliative care engagement in ICU through a stakeholder participatory approach. ⋯ Theory of change framework facilitated the identification of proposed mechanisms and interventions underpinning palliative care integration in ICUs.