Journal of critical care
-
Journal of critical care · Aug 2014
Multicenter StudyThe views of health care professionals about selective decontamination of the digestive tract: An international, theoretically informed interview study.
Selective decontamination of the digestive tract (SDD) as a prophylactic intervention improves hospital-acquired infection and survival rates. Uptake of SDD is low and remains controversial. This study applied the theoretical domains framework to assess intensive care unit clinicians' views about SDD in regions with limited or no adoption of SDD. ⋯ We identified salient beliefs, barriers, and facilitators to SDD adoption and delivery. What participants said about SDD and the way in which they said it demonstrated the degree of clinical caution, uncertainty, and concern that SDD evokes.
-
Journal of critical care · Aug 2014
Hyperglycemia, hypoglycemia, and glycemic complexity are associated with worse outcomes after surgery.
The purpose of this study was to determine if glycemic complexity, along with hypoglycemia and hyperglycemia, was associated with worse outcomes after cardiac surgery. ⋯ We found that hypoglycemia (glucose<71 mg/dL) and hyperglycemia (glucose>140 mg/dL) were associated with increased risk of complications, whereas greater complexity of the glucose time series was associated with mortality.
-
Journal of critical care · Aug 2014
Prognostic factors in critically ill cancer patients admitted to the intensive care unit.
The objective of this study is to identify factors predicting intensive care unit (ICU) mortality in cancer patients admitted to a medical ICU. ⋯ Intensive care unit mortality rate was 55% in our cancer patients, which suggests that patients with cancer can benefit from ICU admission. We also found that ICU mortality rates of patients with hematological malignancies and solid tumors were similar.
-
Journal of critical care · Aug 2014
Family experience with intensive care unit care: Association of self-reported family conferences and family satisfaction.
A family conference is recommended as a best practice to improve communication in the intensive care unit (ICU), but this can be challenging given the setting. This study examined whether family members who reported that a family conference occurred had higher satisfaction than those who did not report that a conference was held. ⋯ This study confirms that families who report attending family conferences are more satisfied with decision making in the ICU. This study highlights the need to increase communication in ICUs.
-
Journal of critical care · Aug 2014
Controlling mechanical ventilation in acute respiratory distress syndrome with fuzzy logic.
The current ventilatory care goal for acute respiratory distress syndrome (ARDS) and the only evidence-based approach for managing ARDS is to ventilate with a tidal volume (VT) of 6 mL/kg predicted body weight (PBW). However, it is not uncommon for some caregivers to feel inclined to deviate from this strategy for one reason or another. To accommodate this inclination in a rationalized manner, we previously developed an algorithm that allows for VT to depart from 6 mL/kg PBW based on physiological criteria. The goal of the present study was to test the feasibility of this algorithm in a small retrospective study. ⋯ Within the limits imposed by a small retrospective study, we conclude that our fuzzy logic algorithm makes sensible decisions while at the same time keeping practice close to the current ventilatory care goal.