Journal of critical care
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Journal of critical care · Aug 2012
Evaluation of consulting and critiquing decision support systems: effect on adherence to a lower tidal volume mechanical ventilation strategy.
Our hypothesis was that both styles are effective to decrease tidal volume (V(T)) but that critiquing comprises the most effective strategy. The purpose of this study is to test this hypothesis by measuring the effect of an active computerized decision support system, in 2 communication styles, consulting and critiquing, on adherence to V(T) recommendations. ⋯ The use of a CDSS in both communication styles improved the use of lower V(T)s for ventilated patients. When decision support was not sustained, adherence to low V(T) fell back to its original value. Interestingly, the consulting style had a slightly larger effect. This may stem from the high frequency of showing reminders in this style and the relatively simple underlying guideline where its display implies the associated action of lowering V(T). The consulting style, however, was more interruptive for clinicians, calling upon the need to strike a balance between effect and intrusiveness.
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Journal of critical care · Aug 2012
Prevalence and characteristics of nonlactate and lactate expressors in septic shock.
The study's objective was to determine the proportion and patient characteristics of patients in vasopressor-dependent septic shock who presented without lactatemia. ⋯ Almost one-half of patients with vasopressor-dependent septic shock did not express lactate on presentation, although a high mortality rate remains in this population. We found a significant association between lactate expressors and liver disease and between lactate expressors and positive blood cultures. The use of lactatemia as the sole indicator of need for additional intravenous fluid or an end point of resuscitation in septic shock may be inadequate.
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Journal of critical care · Aug 2012
Comparative StudyStaff satisfaction between 2 models of care for the chronically critically ill.
Chronically critically ill (CCI) patients are a growing population in intensive care units (ICUs), and evidence suggests that this patient group is perceived as demanding by healthcare professionals. However, information is scarce regarding organizational factors that affect staff satisfaction during the care of CCI patients. ⋯ Results from this study provide information about health-care professionals' perceived burden of care when treating CCI patients. Strategies promoting professional development have a potential to increase staff satisfaction when it comes to the care of this patient group.
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Journal of critical care · Aug 2012
Clinical TrialCerebral vasoreactivity to acetazolamide is not impaired in patients with severe sepsis.
The pathophysiology of sepsis-associated encephalopathy (SAE) is not entirely clear, but one of the possible underlying mechanisms is the alteration of the cerebral microvascular function. The aim of the present work was to test whether cerebral vasomotor reactivity is impaired in patients with severe sepsis. ⋯ We conclude that cerebrovascular reactivity is not impaired in patients with severe sepsis. It is conceivable that cerebral vasoreactivity may be differently involved at different severity stages of the septic process.
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Journal of critical care · Aug 2012
Comparative StudyCaution when using prognostic models: a prospective comparison of 3 recent prognostic models.
Prognostic models have been developed to estimate mortality and to compare outcomes in different intensive care units. However, these models need to be validated before their use in different populations. In this study, we assessed the performance of 3 recently developed general prognostic models (Acute Physiologic and Chronic Health Evaluation [APACHE] IV, Simplified Acute Physiology Score [SAPS] 3 and Mortality Probability Model III [MPM(0)-III]) in a population admitted at 3 medical-surgical Brazilian intensive care units. ⋯ In this study, all models showed poor calibration, while discrimination was very good for all of them. As this has been a common finding in validation studies, caution is warranted when using prognostic models for benchmarking.