Journal of critical care
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Journal of critical care · Feb 2020
Review Historical ArticleThe history of critical care in Kenya.
Critical care is a young specialty in Kenya. From its humble beginnings in the 1960s to present day Kenya, the bulk of this service has largely been provided by anaesthetists. We provide a detailed account of the growth and development of this specialty in our country, the attempts made by our people to grow this service within our borders and the vital role our international partners have played throughout this process. We also share a selection of our successes over the years, the challenges we have faced and our aspirations as we look to the future.
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Journal of critical care · Dec 2019
Meta AnalysisNon-opioid analgesics as adjuvants to opioid for pain management in adult patients in the ICU: A systematic review and meta-analysis.
To identify the impact of non-opioid analgesics as adjuvants to opioid on opioid consumption and its side effects, as well as the analgesic effectiveness in adult patients in the ICU. ⋯ Non-opioid analgesics as adjuvants to opioid reduced the consumption and the side effects of opioids in adult surgical and Guillain-Barre syndrome patients in the ICU.
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Journal of critical care · Dec 2019
Review Case ReportsSepsis induced cardiomyopathy: Pathophysiology and use of mechanical circulatory support for refractory shock.
Sepsis remains a major cause of morbidity and mortality, and sepsis-induced cardiomyopathy (SCM) has been recognized as a relevant complication. In this article, the pathophysiology of SCM and the literature regarding the clinical care with a focus on the use of mechanical circulatory support for the rescue of patients with severe SCM are reviewed. Lastly, a pragmatic approach to the care of this complex patient population is provided using a representative case example.
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Journal of critical care · Dec 2019
ReviewManaging the Alpha-1 patient in the ICU: Adapting broad critical care strategies in AATD.
Alpha-1 Antitrypsin Deficiency (AATD) is a progressive pulmonary disease under-recognized or misdiagnosed by clinicians. Patients with AATD can develop a variety of organ-specific complications and as a result, often require hospitalization and treatment within critical care and ICU settings. ⋯ In addition, we have outlined certain aspects of the care of this patient population that may be of interest to critical care practitioners. With greater disease awareness and earlier diagnosis the onset of symptoms can be delayed, which will ultimately reduce the frequency of deleterious health consequences.
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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.