Journal of critical care
-
Journal of critical care · Jun 2009
ReviewLow-molecular-weight heparin thromboprophylaxis in medical-surgical critically ill patients: a systematic review.
The study aimed to systematically review the effect of low-molecular-weight heparin (LMWH) thromboprophylaxis in medical-surgical critically ill patients in the intensive care unit. ⋯ Low-molecular-weight heparin may be effective for thromboprophylaxis in medical-surgical critically ill patients, but no trials have compared LMWH against an alternative active strategy; thus, LMWH cannot be recommended routinely. Trials testing LMWH thromboprophylaxis are required, which examine patient-important end points such as the incidence and clinical consequences of VTE, bleeding, heparin-induced thrombocytopenia, and mortality.
-
Journal of critical care · Jun 2009
Prophylaxis against venous thromboembolism in neurointensive care patients: survey of Canadian practice.
Although anticoagulant thromboprophylaxis reduces the incidence of venous thromboembolism in critically ill patients, it may increase the risk of devastating bleeding complications in neurosurgical patients. For this population, anticoagulant thromboprophylaxis remains controversial and randomized controlled studies are sparse. Our goal was to establish sufficient clinical equipoise to facilitate future research in this area. ⋯ Most Canadian physicians reported using anticoagulant thromboprophylaxis after neurosurgery, although practice patterns differed as to when and for whom. Future research should quantify the benefits and risks in relation to the time of initiation in different neurosurgical subgroups. Our results suggest there is equipoise regarding the use of anticoagulation thromboprophylaxis in neurosurgical patients. Therefore randomized controlled trials are justifiable and needed to guide clinicians.
-
Journal of critical care · Jun 2009
Characteristics of discussions on cardiopulmonary resuscitation between physicians and surrogates of critically ill patients.
In the intensive care unit (ICU), critically ill patients are often unable to participate in discussions about cardiopulmonary resuscitation (CPR), and decisions on CPR are often made by surrogate decision makers. The objective of this study is to determine the prevalence, content, and perceptions of CPR discussions between critically ill patients' surrogates and ICU physicians and their effect on resuscitation decisions. ⋯ Only half of critically ill patients' surrogates participated in CPR discussions. For those who did participate, most reported good understanding of resuscitation techniques, but less than half recalled the core components of CPR.
-
Journal of critical care · Jun 2009
The impact of do-not-resuscitate order on triage decisions to a medical intensive care unit.
To determine whether the presence of a do-not-resuscitate (DNR) order impacts on triage decisions to a medical intensive care unit (MICU) of an academic medical center. ⋯ The presence of a DNR order at the time of MICU consultation was significantly associated with the decision to refuse a patient to the MICU.
-
Journal of critical care · Jun 2009
Outcome of early intensive care unit patients readmitted in the same hospitalization.
The aim of the study was to evaluate factors associated with early readmission to the intensive care unit (ICU) during the same hospitalization and factors associated with adverse outcomes. ⋯ Patients with respiratory and cardiovascular diseases are at greatest risk for early ICU readmission. Better patient assessment and knowledge of factors associated with early readmission may contribute to reduced mortality.