Journal of critical care
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Journal of critical care · Feb 2022
Drastic changes in the practice of end-of-life care during the COVID-19 pandemic.
This article discusses drastic changes in the practice of end-of-life care during the COVID-19 pandemic. It reviews the ethical dilemmas of individual autonomy versus societal justice, human beneficence versus public health non-maleficence that arose during the pandemic due to prolonged, high acutity,= critical illness in the setting of a highly contageous respiratory virus, protective personal equipment shortages,m crisis standards of care to distribute scarce medical resources, and changes in interactions between treating clinicians, patients, and visitors. The lessons learned during the pandemic response will directly inform and impact the appraoch to future pandemic events.
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Journal of critical care · Feb 2022
A retrospective evaluation of three ethical triage tools for the allocation of ICU resources during the first wave of the COVID-19 pandemic.
To retrospectively evaluate the effect of ethical triage tools (ETT), designed to streamline the admission of patients during the first wave of the COVID-19 pandemic. We aimed to determine the characteristics and outcomes of the patients who would have been denied admission to the ICU according to these protocols, including the cumulative number of saved ICU days. ⋯ An ETT effectively reduces ICU bed occupancy but it does not accurately discriminate between survivors and non-survivors, as a substantial percentage of patients who are being denied admission to the ICU would eventually survive their hospital stay.
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Journal of critical care · Feb 2022
Accuracy of a modified 4Ts score in predicting heparin-induced thrombocytopenia in critically ill patients: A pilot study.
Thrombocytopenia is common among critically ill patients and heparin-induced thrombocytopenia (HIT) is often on the differential. Professional guidelines recommend calculating a pre-test probability score before performing HIT testing. The 4Ts score is widely utilized but accuracy has been questioned in critically ill patients. The HIT Expert Probability (HEP) score is available, but complexity limits use. Our objective was to compare a modified intensive care unit (ICU)-4Ts score to available scoring tools. ⋯ The ICU-4Ts score better predicted the diagnosis of HIT compared to the 4Ts score. Prospective validation studies are needed to confirm these results.
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Journal of critical care · Feb 2022
Observational StudyCircadian variation in new-onset atrial fibrillation in patients in ICUs.
New-onset atrial fibrillation (NOAF) is common in patients treated on an intensive care unit (ICU). Onset of certain arrhythmias exhibit circadian variation. Whether NOAF follows a circadian rhythm in patients in ICU is unknown. ⋯ We identified 2017 patients who developed NOAF during their ICU stay. NOAF onset exhibited a bimodal distribution with peaks at 8 am and 8 pm, consistent with the onset of paroxysmal AF in patients in the community. Future studies in ICUs should record time of AF onset, as understanding high risk periods may inform timing of preventative interventions.
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Journal of critical care · Feb 2022
Real time wire localization by ultrasound during central line insertion improves accurate positioning in all upper torso sites.
To investigate whether point of care ultrasound can improve central venous catheter tip positioning. ⋯ Point of care ultrasound for guidewire identification and localization, while inserting central venous catheter from all upper torso sites, improves precision positioning.