Journal of critical care
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Journal of critical care · Jun 2013
Contributions of tele-intensive care unit (Tele-ICU) technology to quality of care and patient safety.
The deployment of remote monitoring of intensive care unit (ICU) patients, known as tele-ICU technology, promotes the efficient use of critical care resources. Although tele-ICU use has spread rapidly, the benefits vary widely among studies, and little is known about the specific characteristics of tele-ICU that provide benefits to patient care. The purpose of this study was to identify aspects of tele-ICU that contribute, whether positively or negatively, to care processes and patient outcomes. ⋯ We found that availability of extra resources can reduce on mortality and length of stay, that a tele-ICU could serve as a quality trigger to improve evidence-based medicine compliance, that tele-ICU can support medication management and improve medication safety, and that tele-ICU software alerts and monitoring by camera can help reduce the risk of patient falls and extubations. We also found that tele-ICU physicians can make poor care decisions leading to medication errors if they lack patient-related information. Moreover, the tele-ICU has no impact on patient care processes and outcomes when the technology is not accepted and used by ICU staff.
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Journal of critical care · Jun 2013
Perioperative plasma melatonin concentration in postoperative critically ill patients: its association with delirium.
Delirium is a common complication in postoperative critically ill patients. Although abnormal melatonin metabolism is thought to be one of the mechanisms of delirium, there have been few studies in which the association between alteration of perioperative plasma melatonin concentration and postoperative delirium was assessed. ⋯ Delta melatonin concentration at 1 hour after the operation has a significant independent association with risk of postoperative delirium.
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Journal of critical care · Jun 2013
Delirium assessment using Confusion Assessment Method for the Intensive Care Unit in Chinese critically ill patients.
The aim of this study was to provide a method for delirium evaluation in simplified Chinese for patients speaking this language via validation of a translation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). ⋯ This study affirmed the validity and reliability against reference raters using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition of a brief nursing-conducted method of diagnosing delirium in ICU patients who speak simplified Chinese using the CAM-ICU.
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Journal of critical care · Jun 2013
Cerebral desaturation events in the intensive care unit following cardiac surgery.
Patients may be at high risk for hemodynamic instability in the early postoperative period, with subsequent poor cerebral perfusion and the development of postoperative cerebral oxygen desaturation events (CDEs). Intraoperative CDEs have been associated with postoperative adverse events. However, none of these studies examined the incidence of early postoperative cerebral desaturations. This study was designed to identify the incidence of CDEs (defined as a decrease in SctO2 to less than 60% for at least 60 seconds) in the immediate postoperative period following cardiac surgery. ⋯ A high incidence of CDEs (53%) was found in the early post-cardiac surgery period. Larger studies are needed to determine whether postoperative CDEs are correlated with various physiologic events or are associated with adverse patient outcomes.
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Journal of critical care · Jun 2013
Impact of serum C-reactive protein measurements in the first 2 days on the 30-day mortality in hospitalized patients with severe community-acquired pneumonia: a cohort study.
The purpose of the study is to evaluate the impact of daily consecutive measurements of C-reactive protein (CRP) in the initial 2 days of hospitalization on the 30-day all-cause mortality in patients with severe community-acquired pneumonia (CAP). ⋯ Fractional decrease less than 25% in CRP levels at the second day was significantly associated with 30-day all-cause mortality in hospitalized patients with severe CAP.