Journal of critical care
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The cadre of information pertinent to critical care medicine continues to expand at a tremendous pace, and we must adapt our strategies of medical education to keep up with the expansion. Differences in learners' characteristics can contribute to a mismatch with historical teaching strategies. Simulation is increasingly popular, but still far from universal. ⋯ Directed strategies of assessment and feedback are often suboptimal. Even strategies of accreditation are evolving. This review attempts to summarize salient concepts, suggest resources, and highlight novel strategies to enhance practice and education in the challenging critical care environment.
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Journal of critical care · Jun 2015
ReviewAssessment of preload and fluid responsiveness in intensive care unit. How good are we?
Early recognition and treatment of acute circulatory failure and tissue hypoperfusion are paramount for improving the odds of survival in critically ill patients. Fluid volume resuscitation is the mainstay intervention in redistributive and hypovolemic shock. ⋯ The use of dynamic changes in central venous pressure, pulse pressure, and echocardiography for assessment of inferior vena cava diameter variations during respiration allows prediction of fluid volume responsiveness in hemodynamically unstable patients. The use of these bedside approaches and passive leg raising maneuver, which is a reversible and quick fluid volume challenge, allows timely formulation of treatment strategy in patients with shock.
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Journal of critical care · Jun 2015
Multicenter StudyThe prevalance of and factors associated with intra-abdominal hypertension on admission Day in critically Ill pediatric patients: A multicenter study.
To investigate admission prevalence of intraabdominal hypertension (IAH) and to determine clinical and laboratory characteristics on admission day associated with IAH in critically ill pediatric patients. ⋯ Intra-abdominal hypertension seems to affect nearly half of newly admitted critically ill pediatric patients. Lactate level and the presence of hypothermia seem to be the independent predictors of the presence of IAH.
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Journal of critical care · Jun 2015
Observational StudyThe use of tracheostomy speaking valves in mechanically ventilated patients results in improved communication and does not prolong ventilation time in cardiothoracic intensive care unit patients.
The aim of this study was to assess the effect of the introduction of in-line tracheostomy speaking valves (SVs) on duration of mechanical ventilation and time to verbal communication in patients requiring tracheostomy for prolonged mechanical ventilation in a predominantly cardiothoracic intensive care unit (ICU). ⋯ The purpose of the study was to compare tracheostomy outcomes in mechanically ventilated patients in a cardiothoracic ICU preintroduction and postintroduction of in-line SVs. It was hypothesized that in-line SVs would improve communication and swallowing specific outcomes with no increase in average time to decannulation or the number of adverse events.
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Journal of critical care · Jun 2015
Quadrimodal distribution of death after trauma suggests that critical injury is a potentially terminal disease.
Patterns of death after trauma are changing due to advances in critical care. We examined mortality in critically injured patients who survived index hospitalization. ⋯ ICU LOS during index hospitalization is associated with post-discharge mortality. Patients with prolonged ICU stays after surviving critical injury may benefit from detailed discussions about goals of care after discharge.