Journal of critical care
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Journal of critical care · Dec 2014
Multicenter StudyExperiences with capnography in acute care settings: A mixed-methods analysis of clinical staff.
Although capnography is being incorporated into clinical guidelines, it is not used to its full potential. We investigated reasons for limited implementation of capnography in acute care areas and explored facilitators and barriers to its implementation. ⋯ We observed varied responsiveness to capnography and identified factors that work to foster or discourage its use. These data can guide future implementation strategies. A deliberate strategy to foster utilization, mitigate barriers, and broadly accelerate implementation has the potential to profoundly impact use of capnography in acute care areas with the goal of improving patient care.
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Journal of critical care · Dec 2014
Multicenter Study Observational StudyPharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada.
This study sought to identify the medication class most commonly prescribed for stress ulcer prophylaxis (SUP), assess trends in SUP utilization, and report the use of acid suppressive therapy stratified by bleeding risk. ⋯ Stress ulcer prophylaxis is frequently administered to patients who are not at high risk for clinically important bleeding. Proton pump inhibitors are the overwhelming first choice among practitioners. Several opportunities exist for improvement regarding the provision of SUP.
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Journal of critical care · Dec 2014
Multicenter Study Observational StudyCentral venous pressure after coronary artery bypass surgery: Does it predict postoperative mortality or renal failure?
Although hemodynamic monitoring is often performed after coronary artery bypass grafting (CABG), the role of monitoring postoperative central venous pressure (CVP) measurement as a predictor of clinical outcomes is unknown. As such, this study tests the hypothesis that postoperative CVP is predictive of operative mortality or renal failure. ⋯ Patients' CVP at 6 hours after CABG surgery was highly predictive of operative mortality or renal failure, independent of cardiac index and other important clinical variables. Future studies will need to assess whether interventions guided by postoperative CVP can improve patient outcomes.
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Journal of critical care · Oct 2014
Randomized Controlled Trial Multicenter StudyClonidine in the sedation of mechanically ventilated children: A pilot randomized trial.
Clonidine is often used as a sedative in critically ill children, but its effectiveness has not been evaluated in a large, rigorous randomized controlled trial. Our objectives in this pilot trial were to assess the feasibility of a larger trial with respect to (1) effective screening, (2) recruitment, (3) timely drug administration, and (4) protocol adherence. ⋯ This pilot trial demonstrated feasibility of a larger randomized controlled trial. Some important challenges emerged, allowing refinement of the study protocol and enrolment estimates. We recommend that future trials capitalize on the experience gained and use these results to design a larger trial focusing on clinically important outcomes.
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Journal of critical care · Oct 2014
Multicenter StudyMarkers of poor outcome in patients with acute hypoxemic respiratory failure.
This study described the acute hypoxemic respiratory failure (AHRF) population and identified potential modifiable markers of outcome. ⋯ Lower baseline oxygenation (Pao2/Fio2) is a poor prognostic marker in acute hypoxemic respiratory failure.