Journal of critical care
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Journal of critical care · Dec 2015
Effects of positive end-expiratory pressure on brain tissue oxygen pressure of severe traumatic brain injury patients with acute respiratory distress syndrome: A pilot study.
To verify whether high positive end-expiratory pressure levels can increase brain tissue oxygen pressure, and also their effects on pulse oxygen saturation, intracranial pressure, and cerebral perfusion pressure. ⋯ High positive end-expiratory pressure levels increased brain tissue oxygen pressure and oxygen saturation, without increase in intracranial pressure or decrease in cerebral perfusion pressure. High positive end-expiratory pressure levels can be used in severe traumatic brain injury patients with acute respiratory distress syndrome as a safe alternative to improve brain oxygenation.
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Journal of critical care · Dec 2015
The introduction of basic critical care echocardiography reduces the use of diagnostic echocardiography in the intensive care unit.
Basic critical care echocardiography (CCE) is routinely used by intensive care unit (ICU) providers to rapidly address key hemodynamic questions for the critically ill. By comparison, diagnostic echocardiography (DE) uses a comprehensive examination with more traditional workflow and sophisticated techniques. Despite these differences, both are frequently used to answer similar questions in ICU. This overlap raises questions of duplicate testing and redundancy of hospital resources. We therefore evaluated the effect of the introduction of basic CCE over the use of DE in Victoria Hospital, a tertiary care ICU in London Ontario, Canada. ⋯ In a hospital with a significant increase in basic CCE use, an associated significant decrease in DE use was observed with no increase in adverse outcomes. The significant increase in basic CCE use resulted in a change of management in most cases including the request for DE in a minority of cases.
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Journal of critical care · Dec 2015
Clinically suspected heparin-induced thrombocytopenia during extracorporeal membrane oxygenation.
Patients receiving extracorporeal membrane oxygenation (ECMO) are at risk for thrombocytopenia including heparin-induced thrombocytopenia (HIT). The purpose of this study was to determine the frequency of suspected HIT in patients receiving ECMO and unfractionated heparin (UFH). ⋯ The evaluation of HIT occurred in a small percentage of patients, with HIT rarely being detected. Patients who had heparin-platelet factor 4 immunoassay testing exhibited lower platelet counts with a similar duration of ECMO and UFH exposure.
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Journal of critical care · Dec 2015
Five-year experience with mobile adult extracorporeal membrane oxygenation in a tertiary referral center.
Mobile extracorporeal membrane oxygenation (ECMO) is reserved for critically unstable patients who may not otherwise survive transfer to the ECMO center. We describe our experience with mobile ECMO. ⋯ The use of mobile ECMO in adult patients is a safe modality for transfer of critically unwell patients. We have safely used double-lumen cannulas in most of these patients.
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Journal of critical care · Dec 2015
Risk factors for discharge on a new antipsychotic medication after admission to an intensive care unit.
Increased awareness of delirium in the intensive care unit (ICU) has led to higher use of antipsychotic medications for treatment of delirium. These medications are often not discontinued at ICU or hospital discharge, which may increase the risk of inappropriate polypharmacy. Our study sought to identify risk factors for being discharged on a new antipsychotic medication after admission to a trauma-surgical ICU or neurocritical care unit. ⋯ Those patients with higher Acute Physiology and Chronic Health Evaluation II scores and more benzodiazepine days are at increased odds of being discharged on a new antipsychotic.