Journal of critical care
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Journal of critical care · Dec 2013
ReviewPractical considerations for the dosing and adjustment of continuous renal replacement therapy in the intensive care unit.
Familiarity with the initiation, dosing, adjustment, and termination of continuous renal replacement therapy (CRRT) is a core skill for contemporary intensivists. Guidelines for how to administer CRRT in the intensive care unit are not well documented. ⋯ Management of electrolyte and acid-base derangements commonly encountered with acute renal failure is emphasized. Knowledge regarding the practical aspects of managing CRRT in the intensive care unit is a prerequisite for achieving desired physiological end points.
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Journal of critical care · Dec 2013
Multicenter StudyCommunity-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: Risk factors for mortality.
The aims of this study are to identify factors predicting mortality in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission and to examine whether noninvasive ventilation treatment reduces mortality. ⋯ Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission.
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Journal of critical care · Dec 2013
Combat casualties undergoing lifesaving interventions have decreased heart rate complexity at multiple time scales.
We found that heart rate (HR) complexity metrics such as sample entropy (SampEn) identified patients with trauma receiving lifesaving interventions (LSIs). We now aimed (1) to test a multiscale entropy (MSE) index, (2) to compare it to single-scale measures including SampEn, and (3) to assess different parameter values for calculation of SampEn and MSE. ⋯ Complexity of HR dynamics over a range of time scales was lower in high-risk than in low-risk combat casualties and outperformed traditional vital signs.
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Journal of critical care · Dec 2013
Staff acceptance of a telemedicine intensive care unit program: A qualitative study.
We conducted an evaluation to identify factors related to intensive care unit (ICU) staff acceptance of a telemedicine ICU (Tele-ICU) program in preimplementation and postimplementation phases. ⋯ Telemedicine ICU implementation is complex. Time and resources should be allocated for local coordination, continuous needs assessment for Tele-ICU support, staff training, developing interpersonal relationships, and systems design and evaluation. Such efforts are likely to be rewarded with more rapid staff acceptance of this new technology.
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Journal of critical care · Dec 2013
Potential effect of physiotherapeutic treatment on mortality rate in patients with severe sepsis and septic shock: A retrospective cohort analysis.
The aim of the study was to examine the onset and frequency of physiotherapeutic interventions (PTI) and their potential effects on the intensive care unit (ICU) mortality rate in patients with severe sepsis or septic shock. ⋯ Physiotherapists routinely assess and treat patients with sepsis. The frequency of PTI was associated with an improved outcome. Prospective studies are necessary to confirm the potential favorable impact.