Journal of critical care
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Journal of critical care · Jun 2013
Randomized Controlled TrialCardiac output responses in a flow-driven protocol of resuscitation following cardiac surgery.
Determine the role of cardiac output and central venous pressure (CVP) measurements in the clinical decisions that were based on the algorithm used in a randomized trial that compared a colloid to a crystalloid solution in the management of patients early after cardiac surgery (FACS trial, NCT00337805, Crit Care Med 2010; 38:2117). ⋯ Measurement of cardiac output and CVP significantly influenced clinical decisions in the FACS algorithm.
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Journal of critical care · Jun 2013
Improving the 2007 Infectious Disease Society of America/American Thoracic Society severe community-acquired pneumonia criteria to predict intensive care unit admission.
To improve 2007 Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) severity criteria to predict intensive care unit (ICU) admission in patients hospitalized with pneumonia. ⋯ The addition of arterial pH <7.30 to the 2007 IDSA/ATS major criteria improves sensitivity and AUC to identify patients who will require ICU care.
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Journal of critical care · Jun 2013
A structured educational intervention to improve targeted temperature management utilization after cardiac arrest.
Post-arrest targeted temperature management (TTM) has been shown to dramatically improve outcomes after resuscitation, yet studies have revealed inconsistent and slow adoption. Little is known about barriers to TTM implementation and methods to increase adoption. We hypothesized that a structured educational intervention might increase TTM use. ⋯ A focused TTM program led to increased confidence and usage among participants. Future work will focus on targeted training to address specific barriers and increase TTM utilization.
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Journal of critical care · Jun 2013
Consecutive thrombelastography clot strength profiles in patients with severe sepsis and their association with 28-day mortality: a prospective study.
The aim of this study was to assess associations between consecutive thrombelastography (TEG) profiles and standard coagulation tests and disease severity and mortality in patients with severe sepsis. ⋯ The ICU admission TEG MA remained constant for several days in patients with severe sepsis and hypocoagulable MA independently predicted 28-day mortality.
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Journal of critical care · Jun 2013
A conceptual approach to improving care in pandemics and beyond: severe lung injury centers.
The events of the 2009 influenza pandemic sparked discussion regarding the need to optimize delivery of care to those most severely ill. We propose in this conceptual study that a tiered regionalization care system be instituted for patients with severe acute respiratory distress syndrome. Such system would be a component of national pandemic plans and could also be used in day-to-day operations.