Journal of critical care
-
Journal of critical care · Feb 2019
Pain among non-verbal critically Ill mechanically ventilated patients: Prevalence, correlates and predictors.
To investigate pain levels and factors that are predictive of pain for mechanically ventilated patients during rest and during routine nursing procedures. ⋯ Many mechanically ventilated patients suffer resting and procedural pain. Many variables were found to play a role. Clinicians need to consider these variables and intervene to decrease pain among patients at risk.
-
Journal of critical care · Feb 2019
Randomized Controlled TrialExtracorporeal cytokine adsorption in septic shock: A proof of concept randomized, controlled pilot study.
The aim of this proof of concept, prospective, randomized pilot trial was to investigate the effects of extracorporeal cytokine removal (CytoSorb®) applied as a standalone treatment in patients with septic shock. ⋯ This is the first trial to investigate the effects of early extracorporeal cytokine adsorption treatment in septic shock applied without renal replacement therapy. It was found to be safe with significant effects on norepinephrine requirements, PCT and Big-endothelin-1 concentrations compared to controls.
-
Journal of critical care · Feb 2019
Multicenter Study Observational StudyIntensive care admission criteria for traumatic brain injury patients across Europe.
Within a prospective, observational, multi-center cohort study 68 hospitals (of which 66 responded), mostly academic (n = 60, 91%) level I trauma centers (n = 44, 67%) in 20 countries were asked to complete questionnaires regarding the "standard of care" for severe neurotrauma patients in their hospitals. From the questionnaire pertaining to ICU management, 12 questions related to admission criteria were selected for this analysis. The questionnaires were completed by 66 centers. ⋯ South - Eastern Europe and Israel). Variation in admission policy, primarily of mild TBI patients to ICU exists, even among high-volume academic centers and seems to be largely independent of other center characteristics. The observed variation suggests a role for comparative effectiveness research to investigate the potential benefit and cost-effectiveness of a liberal versus more restrictive admission policies.
-
Journal of critical care · Feb 2019
Focused echocardiography: Dyad versus individual training in an authentic clinical context.
Echocardiography is increasingly being taught to intensive care unit residents. Current training methods require teachers to closely supervise trainees individually, and are time-intensive. To reduce the time burden, dyad training (training in pairs) under simulation conditions has been shown to be non-inferior to individual training. We aimed to validate these preliminary results for focused subcostal echocardiography (FSE), in an authentic clinical context. ⋯ Assuming a 1-point non-inferiority threshold for the mean composite score, dyad training for FSE was non-inferior to individual training.
-
Journal of critical care · Feb 2019
ReviewVasopressin vs noradrenaline: Have we found the perfect recipe to improve outcome in septic shock?
The metabolic and circulatory disturbances in patients with septic shock results in a high mortality rate. There is a lack of high-level evidence on the optimal approach. We present a meta-analysis elucidating the outcomes of regimes with only noradrenaline versus a combination of noradrenaline and vasopressin in managing septic shock. ⋯ The two regimes have equivalent outcomes, but vasopressin has a role in selected patients experiencing less severe septic shock beyond a 36-h period. Further work will make definitive clinical recommendations for optimal strategy of vasopressin or noradrenaline usage.