Journal of critical care
-
Journal of critical care · Oct 2020
ReviewA narrative review of pharmacologic de-resuscitation in the critically ill.
Despite evidence highlighting harms of fluid overload, minimal guidance exists on counteraction via utilization of diuretics in the de-resuscitation phase. While diuretics have been shown to decrease net volume and improve clinical outcomes in the critically ill, a lack of standardization surrounding selection of diuretic regimen or monitoring of de-resuscitation exists. Current monitoring parameters of de-resuscitation often rely on clinical signs of fluid overload, end organ recovery and other biochemical surrogate markers which are often deemed unreliable. ⋯ Loop diuretics are a widely available type of diuretic for removal of volume in patients with sufficient kidney function, with the potential for adjunct diuretics in special circumstances. At present, administration of diuretics within the broad critically ill population fails to find uniformity and often efficacy. Given the lack of randomized controlled trials in this susceptible population, we aim to provide a thorough therapeutic understanding of diuretic pharmacotherapy which is necessary in order to achieve desired goal of fluid balance and improve overall outcomes.
-
Journal of critical care · Oct 2020
Structure and process associated with the efficiency of intensive care units in low-resource settings: An analysis of the CHECKLIST-ICU trial database.
Characteristics of structure and process impact ICU performance and the outcomes of critically ill patients. We sought to identify organizational characteristics associated with efficient ICUs in low-resource settings. ⋯ In low-resource settings, active surveillance of nosocomial infections and the utilization of invasive devices were associated with efficiency, supporting the management and evaluation of performance indicators as a starting point for improvement in ICU.
-
Journal of critical care · Oct 2020
Meta AnalysisExcess mortality risk from sepsis in patients with HIV - A meta-analysis.
Differences in HIV prevalence, access to antiretrovirals and ICU resources may result in wide variation in sepsis mortality in HIV patients. The aim of this study was to perform a meta-analysis to quantify the excess risk of sepsis mortality in HIV patients. ⋯ HIV increases the risk of sepsis mortality compared to seronegative individuals across all time periods and geographic areas. We note that this effect is more pronounced in patients with organ dysfunction.
-
Journal of critical care · Oct 2020
Narrative critical care: A literary analysis of first-person critical illness pathographies.
Life-threatening illness can be devastating for patients as they experience shifting levels of consciousness, recurrent delirium, and repeated setbacks. Narrative Medicine and its sub-discipline Narrative Critical Care increase healthcare professionals' understanding of the patient perspective, and interpretation of their stories is a means to improving practice. ⋯ We uncovered commonalities and differences in storied accounts of critical illness and survival. New insights might enable healthcare professionals to personalize patient care. More consistency is needed during transitions and rehabilitation of intensive care survivors.