Journal of critical care
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Journal of critical care · Aug 2015
ReviewNormal saline instillation before endotracheal suctioning: "What does the evidence say? What do the nurses think?": Multimethod study.
This study aimed to systematically review studies that investigated the effects of normal saline instillation before endotracheal suctioning and to determine the views of nurses concerning this procedure. ⋯ Although the effects of normal saline instillation on hemodynamics and pneumonia incidence remain controversial, this procedure significantly decreases the oxygenation. Therefore, the use of this procedure is not recommended. However, normal saline instillation is used frequently by nurses to manage thick and tenacious secretions in clinical practice. Additional studies are needed to determine the effectiveness of applications that may be alternatives to normal saline instillation in the management of these secretions.
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Journal of critical care · Aug 2015
Review Case ReportsApnea testing on extracorporeal membrane oxygenation: Case report and literature review.
Extracorporeal membrane oxygenation (ECMO) is used to resuscitate patients with cardiovascular collapse or refractory respiratory failure. Determination of death by neurologic criteria requires the performance of an apnea test. Few data exist describing performance of an apnea test in this setting. Understanding of ECMO physiology and mechanics is critical in the efficient and proper delivery of apnea testing. ⋯ According to current guidelines, apnea testing has to be performed after prerequisites have been met and in a fashion where hypercapnia is achieved in the face of stable oxygenation and hemodynamics. Performance of the test during ECMO is feasible.
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Journal of critical care · Aug 2015
Multicenter Study Observational StudySerum melatonin levels are associated with mortality in severe septic patients.
Melatonin in septic patients has been scarcely explored and only in studies of small sample size (maximum 20 patients). Thus, the objective of this study was to determine whether serum melatonin levels are associated with severity, oxidant and inflammatory state, and mortality in a large series of septic patients. ⋯ The novel finding of our study was that serum melatonin levels are associated with mortality in septic patients.
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Journal of critical care · Aug 2015
ReviewPharmacologic prevention and treatment of delirium in intensive care patients: A systematic review.
The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients. ⋯ The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.
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Journal of critical care · Aug 2015
ReviewA "three delays" model for severe sepsis in resource-limited countries.
The developing world carries the greatest burden of sepsis-related mortality, but success in managing severe sepsis in resource-limited countries (RLCs) remains challenging. A "three delays" model has been developed to describe factors influencing perinatal mortality in developing nations. This model has been validated across different World Health Organization regions and has provided the framework for policymakers to plan targeted interventions. Here, we propose a three delays model for severe sepsis in RLCs. ⋯ Characterizing the major barriers to effective treatment of severe sepsis in RLCs frames the problem in a language common to global health circles, which may stimulate further research, streamline treatment, and reduce sepsis-related mortality in the developing world.