Journal of critical care
-
Journal of critical care · Aug 2015
ReviewEarly mobilization in the critical care unit: A review of adult and pediatric literature.
Early mobilization of critically ill patients is beneficial, suggesting that it should be incorporated into daily clinical practice. Early passive, active, and combined progressive mobilizations can be safely initiated in intensive care units (ICUs). Adult patients receiving early mobilization have fewer ventilator-dependent days, shorter ICU and hospital stays, and better functional outcomes. ⋯ Contraindications and perceived barriers to early mobilization, including cost and health care provider views, are identified. Methods of overcoming barriers to early mobilization and enhancing sustainability of mobilization programs are discussed. Optimization of patient outcomes will require further studies on mobilization timing and intensity, particularly within specific ICU populations.
-
Journal of critical care · Aug 2015
Review Meta AnalysisAssociations of fluid overload with mortality and kidney recovery in patients with acute kidney injury: A systematic review and meta-analysis.
Fluid resuscitation is commonly administered to maintain adequate renal perfusion in critically ill patients to prevent or even treat acute kidney injury (AKI). However, recent studies show that fluid overload is common and might be associated with poor outcomes in patients with AKI. Hence, the objective of this study was to assess the associations of fluid overload with mortality and kidney recovery in patients with AKI. ⋯ Fluid overload is associated with an increased risk of mortality in patients with AKI. The evidence of the relationship between fluid overload and kidney recovery is insufficient.
-
Journal of critical care · Aug 2015
ReviewNormal saline instillation before endotracheal suctioning: "What does the evidence say? What do the nurses think?": Multimethod study.
This study aimed to systematically review studies that investigated the effects of normal saline instillation before endotracheal suctioning and to determine the views of nurses concerning this procedure. ⋯ Although the effects of normal saline instillation on hemodynamics and pneumonia incidence remain controversial, this procedure significantly decreases the oxygenation. Therefore, the use of this procedure is not recommended. However, normal saline instillation is used frequently by nurses to manage thick and tenacious secretions in clinical practice. Additional studies are needed to determine the effectiveness of applications that may be alternatives to normal saline instillation in the management of these secretions.
-
Journal of critical care · Aug 2015
Review Case ReportsApnea testing on extracorporeal membrane oxygenation: Case report and literature review.
Extracorporeal membrane oxygenation (ECMO) is used to resuscitate patients with cardiovascular collapse or refractory respiratory failure. Determination of death by neurologic criteria requires the performance of an apnea test. Few data exist describing performance of an apnea test in this setting. Understanding of ECMO physiology and mechanics is critical in the efficient and proper delivery of apnea testing. ⋯ According to current guidelines, apnea testing has to be performed after prerequisites have been met and in a fashion where hypercapnia is achieved in the face of stable oxygenation and hemodynamics. Performance of the test during ECMO is feasible.
-
Journal of critical care · Aug 2015
ReviewPharmacologic prevention and treatment of delirium in intensive care patients: A systematic review.
The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients. ⋯ The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.