Journal of critical care
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Journal of critical care · Apr 2017
A simple hemodynamic parameter to predict clinical worsening in pulmonary arterial hypertension.
Predicting prognosis is a cornerstone in management of pulmonary arterial hypertension. Hemodynamic parameters are among the robust indicators of right ventricular function and prognosis. In this study we have investigated the association of a simple hemodynamic parameter with clinical worsening in pulmonary arterial hypertension. ⋯ The index of cSvO2 includes both parameters of cardiac output and right ventricular filling pressure and might be beneficial in predicting clinical worsening in patients with pulmonary arterial hypertension.
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Journal of critical care · Apr 2017
Perceived safety and efficacy of neuromuscular blockers for acute respiratory distress syndrome among medical intensive care unit practitioners: A multicenter survey.
Neuromuscular blocking agents (NMBAs) are frequently used in patients with acute respiratory distress syndrome (ARDS). The purpose of this survey is to describe providers' knowledge and perceived efficacy and safety of NMBAs in patients with ARDS. ⋯ Providers are knowledgeable about NMBAs, but educational opportunities exist. Perceptions about the efficacy and safety of NMBAs varied among prescribers, and inconsistencies existed in the prioritization of management strategies for ARDS.
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Readmission rate is frequently proposed as a quality indicator because it is related to both patient outcome and organizational efficiency. Currently available studies are not clear about modifiable factors as tools to reduce readmission rate. ⋯ Readmission can be predicted with moderate precision and independent variables associated with readmission are age, severity of disease, type of admission, infection, immunodeficiency and last day noradrenaline use. The latter factor is the only one that can be modified and therefore readmission rate does not meet the criteria to be used as a useful quality indicator.
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Journal of critical care · Apr 2017
Bronchoscopic intubation is an effective airway strategy in critically ill patients.
American Society of Anesthesiologists guidelines recommend the use of bronchoscopic intubation as a rescue technique in critically ill patients. We sought to assess the safety and efficacy of bronchoscopic intubation as an initial approach in critically ill patients. ⋯ Bronchoscopic intubation as an initial strategy in critically ill patients is associated with a higher first-pass success rate than laryngoscopic intubation, and is not associated with an increase in complications.
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Journal of critical care · Apr 2017
Observational StudyAssociation between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury.
In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury. ⋯ In a cohort of brain-injured patients the development of ARDS was not common. Driving pressure was associated with the development of this disease.