Journal of critical care
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Journal of critical care · Dec 2013
Six-day postoperative impact of a standardized nurse observation and escalation protocol: A preintervention and postintervention study.
The purpose of the study is to determine the impact of a standardized nurse observation and escalation protocol on observation frequency, the measurement of vital signs, and the incidence of in-hospital mortality and resurgery. ⋯ The mean patient observation frequency per nursing shift increased from 0.9076 (95% confidence interval [CI], 0.8921-0.9231) preintervention to 0.9940 (95% CI, 0.9708-1.0172; P < .001) postintervention and was lower in case of 6-day postoperative mortality (0.6686 [95% CI, 0.4984-0.8388] vs other patients 0.9475 [95% CI, 0.9340-0.9610]; P = .003) or resurgery (0.8402 [95% CI, 0.7894-0.8909] vs other patients 0.9564 [95% CI, 0.9378-0.9657]; P = .003). The mean number of vital signs measured per observation episode increased from a mean of 1.81 (95% CI, 1.79-1.83) preintervention to 2.45 (95% CI, 2.39-2.51; P < .001) postintervention. The relative risk reduction was 73.7% (95% CI, 22.8-91.0; P = .015) for 6-day postoperative in-hospital mortality and 30.9% (95% CI, 9.5-47.2; P = .007) for 6-day postoperative resurgery.
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Journal of critical care · Dec 2013
Early levels in blood of immunoglobulin M and natural killer cells predict outcome in nonseptic critically ill patients.
Critical illness results in derangements of all components of the immune response. Nonetheless, most of the efforts evaluating immune status in critically ill patients have been done in the field of sepsis. Here we have evaluated the immunity status at intensive care unit (ICU) admission in a cohort of nonseptic critically ill patients and its influence on their outcome. ⋯ In conclusion, our results demonstrate that IgM plays a protective role in critically ill patients with no sepsis, whereas NK cell counts seem to play a deleterious one. Aging and severity at admission affect levels of key factors of the immune system in the blood of these patients.
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Journal of critical care · Dec 2013
Observational StudyBehavior observation of major noise sources in critical care wards.
This study aimed to investigate the behavior patterns of typical noise sources in critical care wards and relate their patterns to health care environment in which the sources adapt themselves in several different forms. ⋯ The lognormal distribution was considered the most appropriate statistical distribution for noise behaviors in terms of the interval and duration patterns. The turning of patients by staff was closely related to the increasing occurrences of noises. Among the observed noises, talking was identified with the highest frequency, shortest intervals, and the longest durations, followed by monitor alarms. The perceived loudness of talking in the nighttime wards was classified into 3 levels (raised, normal, and low). Most people engaged in verbal communication in the single-bed wards that occurred around the Entrance Zone, whereas talking in the multiple-bed wards was more likely to be situated in the Staff Work Zone. As expected, more occurrences of noises along with longer duration were observed in multiple-bed wards rather than single-bed wards. "Monitor plus ventilator alarms" was the most commonly observed combination of multiple noises.
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Journal of critical care · Dec 2013
The Standard of Care and conflicts at the End of Life in critical care: Lessons from medical-legal crossroads and the role of a quasi-judicial tribunal in decision-making.
The goals of this qualitative study were to review the last 7 years of end of life legal decisions within the critical care field to explore how medical benefit is defined and by whom and the role of the standard of care (SoC) in conflict resolution. ⋯ This study can help improve decision-making by debunking myth of variability in determinations of medical benefit and the standards of care at end of life and reveal the pitfalls of legal recourse in resolving intractable conflicts.