Critical care medicine
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Critical care medicine · Oct 2008
Review Meta AnalysisThe effect of a quantitative resuscitation strategy on mortality in patients with sepsis: a meta-analysis.
Quantitative resuscitation consists of structured cardiovascular intervention targeting predefined hemodynamic end points. We sought to measure the treatment effect of quantitative resuscitation on mortality from sepsis. ⋯ This meta-analysis found that applying an early quantitative resuscitation strategy to patients with sepsis imparts a significant reduction in mortality.
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Critical care medicine · Oct 2008
ReviewThe Fourth National Institutes of Health Symposium on the Functional Genomics of Critical Injury: Surviving stress from organ systems to molecules.
Recent strides in computational biology and high-throughput technologies have generated considerable interest in understanding complex biological systems. The application of these technologies to critical illness and injury offers the potential to define adaptive and maladaptive programs of gene expression induced by infection, shock, trauma, or other inflammatory triggers, and to detect biomarkers and genetic polymorphisms linked to these responses and outcome. ⋯ Highlights from the Fourth National Institute of Health Functional Genomics of Critical Illness and Injury Symposium are described herein, in addition to deliverables for the field identified during panel discussions. Next steps for the community and suggestions for future research are presented.
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Critical care medicine · Oct 2008
Multicenter StudyMulticenter implementation of a consensus-developed, evidence-based, spontaneous breathing trial protocol.
Evidence-based practice recommendations abound, but implementation is often unstructured and poorly audited. We assessed the ability of a peer network to implement an evidence-based best practice protocol and to measure patient outcomes. ⋯ Peer networks can be effective in promoting and implementing evidence-based best practices. Implementation of a best practice (spontaneous breathing trial) may be necessary for, but by itself insufficient to achieve, consistent and timely liberation from ventilator support.
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Critical care medicine · Oct 2008
Randomized Controlled Trial Comparative StudyImproving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing.
Delivery of high-quality cardiopulmonary resuscitation increases survival from cardiac arrest, yet studies have shown that cardiopulmonary resuscitation quality is often poor during actual in-hospital resuscitation. Furthermore, recent work has shown that audiovisual feedback alone during cardiopulmonary resuscitation modestly improves performance. We hypothesized that a multimodal training method comprising audiovisual feedback and immediate debriefing would improve cardiopulmonary resuscitation performance among care providers. ⋯ Significant cardiopulmonary resuscitation quality deficits exist among healthcare providers. Debriefing or feedback alone improved cardiopulmonary resuscitation quality, but the combination led to marked performance improvements. Cardiopulmonary resuscitation feedback and debriefing may serve as a powerful tool to improve rescuer training and care for cardiac arrest patients.