Journal of critical care
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Journal of critical care · Feb 2021
EditorialOn predictions in critical care: The individual prognostication fallacy in elderly patients.
Predicting the future course of critical conditions involves personal experience, heuristics and statistical models. Although these methods may perform well for some cases and population averages, they suffer from substantial shortcomings when applied to individual patients. ⋯ This notably applies to triage situations in response to a lack of healthcare resources. We will discuss these issues and argue that analysing longitudinal data obtained from time-limited trials in intensive care can provide a more robust approach to individual prognostication.
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Journal of critical care · Feb 2021
ReviewA mixed methods study to effectively utilize trigger tools in the ICU.
This study aimed to create a trigger tool for our intensive care units (ICUs) to support our departmental quality improvement efforts. ⋯ We used the modified Delphi process to derive consensus-selected triggers to identify ICU specific adverse events with opportunity for improvement in local care. This methodology can be adopted by other centers looking to introduce trigger tools in a manner selective to their practice needs.
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Journal of critical care · Feb 2021
Randomized Controlled TrialEsophageal balloon calibration during Sigh: A physiologic, randomized, cross-over study.
Optimal esophageal balloon filling volume (Vbest) depends on the intrathoracic pressure. During Sigh breath delivered by the ventilator machine, esophageal balloon is surrounded by elevated intrathoracic pressure that might require higher filling volume for accurate measure of tidal changes in esophageal pressure (Pes). The primary aim of our investigation was to evaluate and compare Vbest during volume controlled and pressure support breaths vs. Sigh breath. ⋯ During Sigh breath, applying a calibrated approach for Pes assessment, a higher Vbest was required compared to VCV and PSV tidal breath.
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To document the equipment, resource and bed capacity of Intensive Care Units (ICUs) in the Republic of Ghana. ⋯ Ghana has a significant shortage of critical care beds that are inequitably distributed across the country and a shortfall of intensivists to staff ICUs. A holistic approach that focuses on the key bottlenecks to quality improvement would be required to improve the capacity and quality of critical care delivery.
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Journal of critical care · Feb 2021
Automatic oxygen administration and weaning in patients following mechanical ventilation.
To evaluate efficacy of FreeO2 device in oxygen weaning of patients after being liberated from mechanical ventilation (MV). ⋯ For the purpose of oxygen weaning in patients recovering from MV, automatic O2 titration with FreeO2 was associated with a substantial reduction in O2 delivery and better oxygenation parameters in comparison with constant O2 flow.