Journal of critical care
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Journal of critical care · Apr 2019
ReviewThe state of bereavement support in adult intensive care: A systematic review and narrative synthesis.
Despite advances in medical science, patient death and family bereavement are commonly encountered in adult intensive care units (ICUs). This is the first review to investigate the state of ICU bereavement support globally, and the availability and effectiveness of bereavement support interventions. ⋯ The reviewed evidence was weak, and findings were contextually bound. As such, it is difficult to make recommendations for the most acceptable and effective bereavement support intervention(s). Bereavement support in ICU needs further exploration and clinicians must be adequately trained and supported for the delivery of evidence-informed, culturally competent care.
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Journal of critical care · Apr 2019
ReviewDecision-making in ICU - A systematic review of factors considered important by ICU clinician decision makers with regard to ICU triage decisions.
The ICU is a scarce resource within a high-stress, high-stakes, time-sensitive environment where critically ill patients with life-threatening conditions receive expensive life-sustaining care under the guidance of expert qualified personnel. The implications of decisions such as suitability for admission into ICU are potentially dire and difficult. ⋯ The complex and dynamic ICU triage decision is affected by numerous interacting factors. The literature provides some indication of these factors, but fail to show complexities and interactions between them. A decision tree is proposed. Further research should include a reflection on how decisions for admission to ICU are made, such that a better understanding of these processes can be achieved allowing for improved individual and group consistency.
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Journal of critical care · Apr 2019
Observational StudyDecreasing re-intubation using prophylactic noninvasive ventilation in elderly patients: A propensity-matched study.
Prophylactic noninvasive ventilation (NIV) reduces re-intubation in high-risk patients. However, its effects in elderly patients remain unclear. Here, we investigated the efficacy of prophylactic NIV in elderly patients after a planned extubation. ⋯ Elderly patients received benefits from prophylactic NIV after a planned extubation.
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Journal of critical care · Apr 2019
Doppler-defined pulmonary hypertension in sepsis and septic shock.
The association of pulmonary hypertension (PH) in patients with sepsis is lesser understood. ⋯ In patients with sepsis and septic shock, PH is common and is noted to be associated with higher short and long-term mortality. Further studies are needed to understand the mechanisms by which PH is associated with outcomes.
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Journal of critical care · Apr 2019
Variability in intensive care unit length of stay after liver transplant: Determinants and potential opportunities for improvement.
Recovery after liver transplant (LT) requires extensive resources, including prolonged intensive care unit stays. The objective of this study was to use an assessment tool to determine if LT recipients remain in ICU beyond designated indications. ⋯ Nearly half of the LT recipients remained in ICU an average of 1.6 additional days. Monitoring of organ function appeared to be the most common reason. Opportunities to improve resource utilization could include transfer to an intermediate/progressive care ("step-down") unit.