Journal of critical care
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Journal of critical care · Dec 2012
ReviewUncommon ophthalmologic disorders in intensive care unit patients.
Ophthalmologic complications are frequently encountered in intensive care unit (ICU) patients (Grixti et al. Ocul Surf 2012;10(1):26-42). However, eye care is often overlooked in the critical care setting or just limited to the ocular surface because treatment is focussed on the management of organ failures. ⋯ The most prevalent ophthalmologic disorders identified in critically ill subjects include exposure keratopathy, chemosis, and microbial keratitis. In addition, uncommon eye disorders reported in ICU include metastatic endogenous endophthalmitis, acute primary angle closure, ischemic optic neuropathy, pupil abnormalities, vascular occlusions, and rhino-orbital cerebral mucormycosis. Early diagnosis and effective treatment will help to prevent visual loss.
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Journal of critical care · Dec 2012
Exploring the capacity to ambulate after a period of prolonged mechanical ventilation.
The purposes were to assess the functional recovery of those who survived a prolonged intensive care unit (ICU) stay by reporting the proportion who were able to ambulate independently at hospital discharge and also to examine if the time duration between admission and when the patient first stood impacted on their capacity to ambulate at discharge. ⋯ After a prolonged ICU admission, more than 50% of patients were unable to ambulate independently by hospital discharge, with the time between admission and first stand, being an important predictor of this outcome.
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Journal of critical care · Dec 2012
Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy.
A simple test that could guide successful cessation of continuous renal replacement therapy (CRRT) in critically ill patients would be clinically useful. This study aimed to investigate whether a 2-hour creatinine clearance (2h-CrCl) measurement could more accurately predict successful cessation of CRRT than serum creatinine or urine output alone. ⋯ 2h-CrCl may be a useful measurement to help guide discontinuation from CRRT.
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Journal of critical care · Dec 2012
Randomized Controlled TrialA weaning protocol administered by critical care nurses for the weaning of patients from mechanical ventilation.
The primary objective of this clinical trial of patients on mechanical ventilation was to determine if a weaning protocol implemented solely by nurses could reduce the weaning time relative to usual care (UC). ⋯ The weaning protocol administered by the nurses was safe and reduced the weaning time from mechanical ventilation in patients who were recovering from respiratory failure.
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Journal of critical care · Dec 2012
ReviewRisks of packed red blood cell transfusion in patients undergoing cardiac surgery.
Packed red blood cell (PRBC) transfusion is common in patients undergoing cardiac surgery. Evidence has accumulated demonstrating that such patients can tolerate relatively low hemoglobins, and an extensive body of literature has developed demonstrating that patients undergoing such surgery who receive PRBC are at risk for several adverse outcomes including increased mortality, atrial fibrillation, and more postoperative infections, as well as numerous other complications. The PubMed database was searched for the English language literature on the topic of PRBC transfusion and outcomes in patients undergoing cardiac surgery, as well as alternatives to this intervention. ⋯ The limited prospective data were consistent with the retrospective data, which comprised most of the literature. The preponderance of the literature suggests that patients undergoing cardiac surgery can tolerate lower hemoglobin/hematocrit values than traditionally appreciated. Most published data also indicate that PRBC transfusion should be reserved for patients with an identifiable clinical/physiologic indication fir this intervention, consistent with recent specialty society guidelines.