Journal of critical care
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Journal of critical care · Dec 2019
Multicenter StudyCommunication with patients' families in the intensive care unit: A point prevalence study.
We aimed to describe point of care communication encounters with patients' families in centers with open visitation practices. ⋯ ICUs adopt multiple ways of communicating with family members of critically ill patients. Significant interactions occur outside of traditional family meetings, in a less formal and more frequent fashion. Our study supports development of tools to support best practices within contemporary communication paradigms to support provider, patients and family needs.
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Journal of critical care · Dec 2019
ReviewP-values and significance: The null hypothesis that they are not related is correct.
False signals and therapeutic optimism have led medicine down many a wrong pathway. Apart from the unnecessary costs of care and redundant research expenditure and efforts this has caused, therapies which were eventually discontinued may have come at a staggering cost of lives lost. Still most statistical information in the medical literature is presented with its p-values and little else. ⋯ Data that should always be presented in conjunction with the p-value are the Confidence Intervals, which illustrate the uncertainty inherent to the results, and the Fragility Index, which reflects result robustness. Multiple RCTs should be the standard for implementing change. Ideally these studies should consistently demonstrate p-values <0.005, study and control groups with well separated 95% CIs and high fragility indices.
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Journal of critical care · Dec 2019
Subtherapeutic piperacillin concentrations in neurocritical patients.
Increased renal elimination is the leading cause for subtherapeutic concentrations of renally cleared antibiotics and it has been hypothesized that brain damaged patients in the intensive care unit (ICU) are particularly at risk. The objective of this study is to determine the prevalence of subtherapeutic piperacillin concentrations in neurocritical patients and to investigate if having a neurocritical diagnosis is a risk factor for this. ⋯ Subtherapeutic piperacillin concentrations are common in neurocritical patients yet having a neurocritical admission diagnosis was not identified as an independent risk factor.
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Journal of critical care · Dec 2019
Multicenter StudyA national survey of approaches to manage the ICU patient with opioid use disorder.
Opioid associated admissions to the Intensive Care Unit (ICU) are increasing, but how institutions manage the care of these patients is unknown. We studied the availability of protocols and guidelines in Intensive Care Units (ICUs) for the management of the critically ill patient with opioid use disorder. ⋯ Few institutional guidelines exist to provide clinicians with the tools necessary to prevent harm and promote recovery for this growing and vulnerable ICU population.
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Journal of critical care · Dec 2019
Comparative StudyComparison between logistic regression and machine learning algorithms on survival prediction of traumatic brain injuries.
To compare twenty-two machine learning (ML) models against logistic regression on survival prediction in severe traumatic brain injury (STBI) patients in a single center study. ⋯ The twenty-two ML models selected have capabilities comparable to classical LR model for outcome prediction in STBI patients. Of these, Cubic SVM, Quadratic SVM, Linear SVM performed significantly better than LR.