Journal of critical care
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The intensive care unit (ICU) family meeting is an important forum for discussion about the patient's condition, prognosis, and care preferences; for listening to the family's concerns; and for decision making about appropriate goals of treatment. For patients, families, clinicians, and health care systems, the benefits of early and effective communication through these meetings have been clearly established. Yet, evidence suggests that family meetings still fail to occur in a timely way for most patients in ICUs. ⋯ We first examine factors that may serve as barriers to family meetings. We then share practical strategies that may be helpful in overcoming some of these barriers. Finally, we describe performance improvement initiatives by ICUs in different parts of the country that have achieved striking successes in making family meetings happen.
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Journal of critical care · Dec 2009
Comparative StudyEffects of propofol and dexmedetomidine on indocyanine green elimination assessed with LIMON to patients with early septic shock: a pilot study.
We aimed to select the sedative drug with the least impact on hepatic blood flow in sedation-administered patients. In our study, we aimed to establish whether dexmedetomidine and propofol affect liver function during early septic shock. The hepatic blood flow is evaluated by the transcutaneous assessment of indocyanine green plasma disappearance rate (ICG-PDR) in critically ill patients. ⋯ In our study, we found that neither propofol nor dexmedetomidine infusion affected hepatic blood flow.
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Journal of critical care · Dec 2009
Family meetings made simpler: a toolkit for the intensive care unit.
Although a growing body of evidence has associated the intensive care unit (ICU) family meeting with important, favorable outcomes for critically ill patients, their families, and health care systems, these meetings often fail to occur in a timely, effective, and reliable way. In this article, we describe 3 specific tools that we have developed as prototypes to promote more successful implementation of family meetings in the ICU: (1) a family meeting planner, (2) a meeting guide for families, and (3) a family meeting documentation template. ⋯ We also discuss the role of such tools in structuring a performance improvement initiative. Just as simple tools have helped reduce bloodstream infections, our hope is that the toolkit presented here will help critical care teams to meet the important communication needs of ICU families.
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Delirium is common but underdiagnosed in critical care units, which results in increased morbidity and mortality. This study aimed to evaluate the reliability and validity of diagnosing delirium with the Memorial Delirium Assessment Scale (MDAS) in India. ⋯ Our findings suggest that training junior residents to use a brief screening instrument to diagnose delirium is a reliable and valid option in resource-poor critical care settings.
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Journal of critical care · Dec 2009
Comparative StudyFiberoptic bronchoscopy-assisted percutaneous tracheostomy is safe in obese critically ill patients: a prospective and comparative study.
Obesity has reached epidemic proportions worldwide. In Latin America, 10% to 35% of the population is obese. Obese critically ill patients are at greater risk for requiring intubation and prolonged mechanical ventilation; and in some cases, it is necessary to perform a tracheostomy. ⋯ Percutaneous tracheostomy using the fiberoptic bronchoscopy-assisted Ciaglia Blue Rhino technique is safe for obese critically ill patients when performed by an experienced intensivist.