Journal of critical care
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Journal of critical care · Dec 2016
Effect and mechanism of hydrocortisone on organ function in patients with severe burns.
In patients with severe burns, resuscitation with large volumes of fluid is needed, partly because of an increase in capillary leakage. Corticosteroids might be beneficial by diminishing capillary leakage. This study aimed to assess in severely burned nonseptic patients whether hydrocortisone (HC) improved outcome and diminished capillary leakage. ⋯ Hydrocortisone treatment in severe burned patients without sepsis might improve organ dysfunction possibly because of a reduction in capillary leakage, as reflected by a decrease of proteinuria, an increase of BNP, and diminished fluid resuscitation volumes.
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Journal of critical care · Dec 2016
Measuring intensive care unit performance after sustainable growth rate reform: An example with the National Quality Forum metrics.
Performance measurement is essential for quality improvement and is inevitable in the shift to value-based payment. The National Quality Forum is an important clearinghouse for national performance measures in health care in the United States. ⋯ Crafting performance measures that address core aspects of critical care will be challenging, as current outcome and performance measures have problems with validity. Future quality measures will likely focus on interdisciplinary measures across the continuum of patient care.
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Journal of critical care · Dec 2016
Observational StudyInferior vena cava diameter variation compared with pulse pressure variation as predictors of fluid responsiveness in patients with sepsis.
Currently, physicians employ pulse pressure variation (PPV) as a gold standard for predicting fluid responsiveness. However, employing ultrasonography in intensive care units is increasing, including using the ultrasonography for assessment of fluid responsiveness. Data comparing the performance of both methods are still lacking. This is the reason for the present study. ⋯ The present study demonstrated better performance of the PPV than the IVDV. A threshold value more than 10% may be used for identifying fluid responders.
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Journal of critical care · Dec 2016
Results of implementing a pain management algorithm in intensive care unit patients: The impact on pain assessment, length of stay, and duration of ventilation.
This study aimed to measure the impact of implementing a pain management algorithm in adult intensive care unit (ICU) patients able to express pain. No controlled study has previously evaluated the impact of a pain management algorithm both at rest and during procedures, including both patients able to self-report and express pain behavior, intubated and nonintubated patients, throughout their ICU stay. ⋯ Several outcome variables were significantly improved after implementation of the algorithm compared with the control group.
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Journal of critical care · Dec 2016
Impact of monitoring endotracheal tube cuff leak pressure on postextubation stridor in children.
To determine if implementing a protocol maintaining an air leak when using cuffed endotracheal tubes (ETT) throughout the course of mechanical ventilation (MV) in children would decrease the rate of postextubation stridor (PES). ⋯ Maintaining an appropriate air leak throughout the course of MV using cuffed ETT decreases the rate of PES in children.