Journal of critical care
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Journal of critical care · Feb 2024
Observational StudyPrevalence of life-sustaining treatment limitations in Polish very old intensive care patients (VIPs). A post-hoc analysis of two prospective observational studies.
Several initiatives have recently focused on raising awareness about limitations of treatment in Poland. We aimed to assess if the propensity to limit LST among elderly patients in 2018-2019 increased compared to 2016-2017. ⋯ The clinicians in Poland have become more proactive in limiting LST in critically ill patients ≥80 years old over the studied period, however the prevalence of limitations of LST in Poland remains low.
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Journal of critical care · Feb 2024
Leaving no culture undrawn: Time to revisit the CLABSI and CAUTI metrics.
Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are quality metrics for many ICUs, and financial ramifications can be applied to hospitals and providers who perform poorly on these measures. Despite some perceived benefits to tracking these metrics, there are a range of issues associated with this practice: lack of a solid evidence base that documenting them has led to decreased infection rates, moral distress associated with identifying these infections, problems with their definitions, and others. We discuss each of these concerns while also including international perspectives then recommend practical steps to attempt to remediate use of the CLABSI and CAUTI metrics. Specifically, we suggest forming a task force consisting of key stakeholders (e.g., providers, Centers for Medicare & Medicaid Services (CMS), patients/families) to review CLABSI and CAUTI-related issues and then to create a summary statement containing recommendations to improve the use of these metrics.
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Journal of critical care · Feb 2024
Observational StudyResuscitative transesophageal echocardiography during the acute resuscitation of trauma: A retrospective observational study.
Resuscitative transesophageal echocardiography (TEE) is an emerging POCUS modality that can be used to guide trauma resuscitation. ⋯ Resuscitative TEE during acute trauma care has an additional diagnostic yield to existing diagnostic pathways and may impact definitive management for some patients in the trauma bay.
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Journal of critical care · Feb 2024
Smartphone applications for measuring noise in the intensive care unit: A feasibility study.
This study aims to explore the suitability of using smartphone applications with low-cost external microphones in measuring noise levels in intensive care units. ⋯ Smartphone apps and low-cost external microphones can be used reliably to measure the average noise level in the intensive care unit after acoustic calibration. However, professional equipment is still necessary for accurate measurement of the maximum noise level.
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Journal of critical care · Feb 2024
Malglycemia in the critical care setting. Part II: Relative and absolute hypoglycemia.
The relationship between critical care mortality and hypoglycemia, both relative (>30% below average preadmission glycemia) and absolute (blood glucose (BG) <70 mg/dL (<10 mmol/L)) requires further definition. ⋯ Relative hypoglycemia represented by excursions below GR 0.7 in those with HbA1c ≥ 8% occurred commonly and was independently associated with mortality. Absolute hypoglycemia had similar association with mortality regardless of HbA1c.