Journal of critical care
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Journal of critical care · Jun 2015
Multicenter Study Comparative StudyImpact of case volume on aneurysmal subarachnoid hemorrhage outcomes.
To compare aneurysmal subarachnoid hemorrhage (aSAH) outcomes between high- and low-volume referral centers with dedicated neurosciences critical care units (NCCUs) and shared neurosurgical, endovascular, and neurocritical care practitioners. ⋯ The noninferior outcomes at the lower SAH volume center suggests that provider expertise, not patient volume, is critical to providing high-quality specialized care.
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Journal of critical care · Jun 2015
ReviewA systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters.
The aim of this study was to collect and describe all published reports of local tissue injury or extravasation from vasopressor administration via either peripheral intravenous (IV) or central venous catheter. ⋯ Published data on tissue injury or extravasation from vasopressor administration via peripheral IVs are derived mainly from case reports. Further study is warranted to clarify the safety of vasopressor administration via peripheral IVs.
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Journal of critical care · Jun 2015
Randomized Controlled Trial Observational StudyExercise-based rehabilitation after hospital discharge for survivors of critical illness with intensive care unit-acquired weakness: A pilot feasibility trial.
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Major complications associated with cardiac surgery are still common and carry great prognostic significance. β-Blockers, statins, antiplatelets, and renin-angiotensin system (RAS) blockers are current medical interventions to prevent cardiovascular complications in cardiac surgery. Renin-angiotensin system blockers include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and antialdosterones. Several lines of evidence support the cardioprotective effects of RAS blockers: they reduce ischemic events and improve outcome in heart failure independently of their effect on heart function and blood pressure. ⋯ Results from clinical trials and observational studies are conflicting, and they raise more questions than answers. Further studies are needed to examine whether RAS blockers reduce mortality and major complications in patients undergoing cardiac surgery. In this review, we discuss the use of RAS blockers in the setting of cardiac surgery, underlying the potential benefits in reducing postoperative complications.
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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.