Journal of critical care
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Journal of critical care · Dec 2009
Multicenter StudyMore men than women are admitted to 9 intensive care units in British Columbia.
The aim of this study is to determine if more males than females are admitted to adult intensive care units (ICUs). ⋯ More men than women are admitted to ICUs; this difference is especially prominent in elderly patients.
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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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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
History of mechanical ventilation may affect respiratory mechanics evolution in acute respiratory distress syndrome.
The aim of this study was to investigate the effect of mechanical ventilation (MV) before acute respiratory distress syndrome (ARDS) on subsequent evolution of respiratory mechanics and blood gases in protectively ventilated patients with ARDS. ⋯ In protectively ventilated patients with ARDS, late alteration of respiratory mechanics occurs more commonly in patients who have been ventilated before ARDS onset, suggesting that the history of MV affects the subsequent progress of ARDS even when using protective ventilation.
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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.