Journal of critical care
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Journal of critical care · Apr 2018
Pre-hospital frailty and hospital outcomes in adults with acute respiratory failure requiring mechanical ventilation.
We aimed to estimate the independent effect of pre-hospital frailty (PHF) on hospital mortality and prolonged hospital length of stay (pLOS) while adjusting for other patient level factors. ⋯ PHF, identified by frailty diagnoses from before index hospitalization, may be a useful approach for identifying adults with ARF at increased risk of hospital mortality and pLOS.
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Journal of critical care · Apr 2018
Rate of low tidal volume ventilation use remains low in patients with acute respiratory distress syndrome despite improvement efforts at a single center.
Low tidal volume ventilation (LTVV) reduces mortality in acute respiratory distress syndrome (ARDS) patients. Understanding local barriers to LTVV use at a former ARDS Network hospital may provide new insight to improve LTVV implementation. ⋯ Most ARDS patients did not receive LTVV despite implementation of a protocol. ARDS was also recognized in a minority of patients, suggesting an opportunity for improvement of care.
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Journal of critical care · Apr 2018
Single intervention for a reduction in portable chest radiography (pCXR) in cardiovascular and surgical/trauma ICUs and associated outcomes.
Studies suggest that "on-demand" radiography is equivalent to daily routine with regard to adverse events. In these studies, provider behavior is controlled. Pragmatic implementation has not been studied. ⋯ In critically ill adults, pCXR reduction can be achieved in cardiothoracic and trauma/surgical patients with a pragmatic intervention, without adversely affecting patient care, outside a controlled study.
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Journal of critical care · Apr 2018
Improving ICU services in resource-limited settings: Perceptions of ICU workers from low-middle-, and high-income countries.
To evaluate perceptions of intensive care unit (ICU) workers from low-and-middle income countries (LMICs) and high income countries (HICs). ⋯ LMICs ICU workers perceived lack of training, lack of nurses, and low wages as major barriers to functioning. Training, increase of nurse workforce, and collection of outcome data were proposed as useful strategies to improve LMIC ICU services.
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Journal of critical care · Apr 2018
Randomized Controlled TrialEarlier and enhanced rehabilitation of mechanically ventilated patients in critical care: A feasibility randomised controlled trial.
Systematic reviews of early rehabilitation within intensive care units have highlighted the need for robust multi-centre randomised controlled trials with longer term follow up. This trial aims to explore the feasibility of earlier and enhanced rehabilitation for patients mechanically ventilated for ≥5days and to assess the impact on possible long term outcome measures for use in a definitive trial. ⋯ We have demonstrated the feasibility of introducing a structured programme of rehabilitation for patients admitted to critical care.