Journal of critical care
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Journal of critical care · Aug 2020
Multicenter StudyPrognostic capability of the Maximum Acute Gastrointestinal Injury Score and of caloric intake in patients requiring vasopressors: A multicenter prospective cohort study.
Our main objective was to use the Maximum Acute Gastrointestinal Injury Score (AGImax) to evaluate the prognostic capability of gastrointestinal dysfunction (GID), on hospital mortality in patients on mechanical ventilation (MV) requiring vasopressors. A secondary goal was to analyze the relationship between AGImax and vasopressor dosage with increasing caloric intake. ⋯ In this population, patients with AGImax III-IV were significantly associated with lower caloric intake and greater hospital mortality, highlighting the importance of AGI as a prognostic tool. As PN was linked with lower mortality, it could be an option to explore in further studies.
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Journal of critical care · Aug 2020
ReviewEthical content of expert recommendations for end-of-life decision-making in intensive care units: A systematic review.
Intensive care unit health care professionals must be skilled in providing end-of-life care. Crucial in this kind of care is end-of-life decision-making, which is a complex process involving a variety of stakeholders and requiring adequate justification. The aim of this systematic review is to analyse papers tackling ethical issues in relation to end-of-life decision-making in intensive care units. It explores the ethical positions, arguments and principles. ⋯ We have demonstrated that recommendations and guidelines designed specifically by intensive or critical care experts for intensive care units promote similar ethical positions, with minimal dissenting positions.
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Journal of critical care · Aug 2020
Observational StudyClinical presentation and initial management critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Brescia, Italy.
An ongoing pandemic of COVID-19 that started in Hubei, China has resulted in massive strain on the healthcare infrastructure in Lombardy, Italy. The management of these patients is still evolving. ⋯ ICU patients with COVID-19 frequently have hypertension. Many could be managed with noninvasive ventilation, despite the risk of aerosolization. The use of a severity scale augmented clinician management.
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Journal of critical care · Aug 2020
Associations between hospital occupancy, intensive care unit transfer delay and hospital mortality.
Hospital occupancy (HospOcc) pressures often lead to longer intensive care unit (ICU) stay after physician recognition of discharge readiness. We evaluated the relationships between HospOcc, extended ICU stay, and patient outcomes. ⋯ ICU transfer delay exponentially increased above a threshold hospital occupancy and may be associated with increased hospital mortality.
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Journal of critical care · Aug 2020
Randomized Controlled Trial Observational StudyContent analysis of bowel protocols for the management of constipation in adult critically ill patients.
Alterations in bowel habits are common during critical illness, and bowel protocols are gaining acceptance. Our objective was to characterize bowel protocols in a cross-sectional analysis of ICUs. ⋯ Bowel protocols have variable initiation, escalation, and discontinuation criteria incorporating different classes of laxatives, reflecting unclear evidence about optimal bowel management strategies in ICU.