Journal of critical care
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Journal of critical care · Feb 2014
Sublingual microcirculation in patients with intra-abdominal hypertension: A pilot study in 15 critically ill patients.
The purpose of the study is to clarify whether increased intra-abdominal pressure (IAP) is associated with sublingual microcirculatory alterations in intensive care patients. ⋯ Neither grade I or II intra-abdominal hypertension (IAP from 12 to 18 mm Hg) is associated with significant changes of sublingual microcirculation in intensive care patients. Correlation analysis indicates better microvascular blood flow at higher mean arterial pressure and abdominal perfusion pressure levels.
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Journal of critical care · Feb 2014
Intensive care specialists' knowledge, attitudes, and professional use of published research evidence: A mail-out questionnaire survey of appropriate use of research evidence in clinical practice.
This survey investigates the knowledge, attitudes, and use of published research in clinical practice by intensive care specialists. ⋯ Respondents reported generally positive attitudes toward using published research evidence, in clinical practice; however, room for improvement in technical knowledge relating to published research evidence was noted.
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Journal of critical care · Feb 2014
Validation of noninvasive pulse contour cardiac output using finger arterial pressure in cardiac surgery patients requiring fluid therapy.
Nexfin (Edwards Lifesciences, Irvine, CA) allows for noninvasive continuous monitoring of blood pressure (ABPNI) and cardiac output (CONI) by measuring finger arterial pressure (FAP). To evaluate the accuracy of FAP in measuring ABPNI and CONI as well as the adequacy of detecting changes in ABP and CO, we compared FAP to intra-arterially measured blood pressure (ABPIA) and transpulmonary thermodilution(COTD) in post cardiac surgery patients during a fluid challenge (FC). ⋯ Finger arterial pressure reliably measures ABP and adequately tracks changes in ABP. Although CONI is not interchangeable with COTD, it follows changes in CO closely.
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Journal of critical care · Feb 2014
Ventilator settings and monitoring parameter targets for initiation of continuous mandatory ventilation: A questionnaire study.
To inform development of educational tools, we sought to identify initial ventilator settings and monitoring targets for 3 scenarios. ⋯ Lung protective ventilation was favored, yet distinct differences in ventilator settings were evident. Monitoring targets suggested relatively conservative practices for Fio2 reduction but an understanding of permissive hypercapnia.
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Journal of critical care · Feb 2014
Utilization and impact on fellowship training of non-physician advanced practice providers in intensive care units of academic medical centers: a survey of critical care program directors.
Non-physician advanced practice providers (APPs) such as nurse practitioners and physician assistants are being increasingly utilized as critical care providers in the United States. The objectives of this study were to determine the utilization of APPs in the intensive care units (ICU)s of academic medical centers (AMCs) and to assess the perceptions of critical care fellowship program directors (PDs) regarding the impact of these APPs on fellowship training. ⋯ Our survey revealed that APPs are utilized in a large number of US AMCs with critical care training programs. Program director respondents believed that patient care and fellowship training were positively impacted by APPs.