Critical care medicine
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Critical care medicine · Jun 2013
Effect of a Multifaceted Performance Feedback Strategy on Length of Stay Compared With Benchmark Reports Alone: A Cluster Randomized Trial in Intensive Care.
To assess the impact of applying a multifaceted activating performance feedback strategy on intensive care patient outcomes compared with passively receiving benchmark reports. DESIGN:: The Information Feedback on Quality Indicators study was a cluster randomized trial, running from February 2009 to May 2011. SETTING:: Thirty Dutch closed-format ICUs that participated in the national registry. Study duration per ICU was sixteen months. PATIENTS:: We analyzed data on 25,552 admissions. Admissions after coronary artery bypass graft surgery were excluded. INTERVENTION:: The intervention aimed to activate ICUs to undertake quality improvement initiatives by formalizing local responsibility for acting on performance feedback, and supporting them with increasing the impact of their improvement efforts. Therefore, intervention ICUs established a local, multidisciplinary quality improvement team. During one year, this team received two educational outreach visits, monthly reports to monitor performance over time, and extended, quarterly benchmark reports. Control ICUs only received four standard quarterly benchmark reports. MEASUREMENTS AND ⋯ In the context of ICUs participating in a national registry, applying a multifaceted activating performance feedback strategy did not lead to better patient outcomes than only receiving periodical registry reports.
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Critical care medicine · Jun 2013
Pleural Pressure and Optimal Positive End-Expiratory Pressure Based on Esophageal Pressure Versus Chest Wall Elastance: Incompatible Results.
1) To compare two published methods for estimating pleural pressure, one based on directly measured esophageal pressure and the other based on chest wall elastance. 2) To evaluate the agreement between two published positive end-expiratory pressure optimization strategies based on these methods, one targeting an end-expiratory esophageal pressure-based transpulmonary pressure of 0 cm H2O and the other targeting an end-inspiratory elastance-based transpulmonary pressure of 26 cm H2O. DESIGN:: Retrospective study using clinical data. SETTING:: Medical and surgical ICUs. PATIENTS:: Sixty-four patients mechanically ventilated for acute respiratory failure with esophageal balloons placed for clinical management. ⋯ Esophageal pressure and chest wall elastance-based methods for estimating pleural pressure do not yield similar results. The strategies of targeting an end-expiratory esophageal pressure-based transpulmonary pressure of 0 cm H2O and targeting an end-inspiratory elastance-based transpulmonary pressure of 26 cm H2O cannot be considered interchangeable. Finally, chest wall and respiratory system elastances may vary unpredictably with changes in positive end-expiratory pressure. (Crit Care Med 201;41:0-0).
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Critical care medicine · Jun 2013
Atypical Sleep in Ventilated Patients: Empirical Electroencephalography Findings and the Path Toward Revised ICU Sleep Scoring Criteria.
Standard sleep scoring criteria may be unreliable when applied to critically ill patients. We sought to quantify typical and atypical polysomnographic findings in critically ill patients and to begin development and reliability testing of methodology to characterize the atypical polysomnographic tracings that confound standard sleep scoring criteria. DESIGN:: Prospective convenience sample. SETTING:: Two academic, tertiary care medical centers. PATIENTS:: Thirty-seven critically ill, mechanically ventilated, medical ICU patients. INTERVENTIONS:: None. MEASUREMENTS AND MAIN ⋯ Analysis of polysomnographic data revealed profound deficiencies in standard scoring criteria due to a predominance of atypical polysomnographic findings in ventilated patients. The revised scoring scheme proved reliable in sleep staging and may serve as a building block in future work.
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Critical care medicine · Jun 2013
Bacteremia in the Patients With Acute Pancreatitis as Revealed by 16S Ribosomal RNA Gene-Based Techniques.
To define the characteristic of bacteremia in the patients with acute pancreatitis and determine its possible association with the disease severity. DESIGN:: A prospective controlled study. SETTING:: ICU of Jinling Hospital, China. PATIENTS:: A total of 48 patients with mild or severe acute pancreatitis were enrolled in this study. INTERVENTIONS:: None. MEASUREMENTS AND MAIN ⋯ This study provides a detailed description on the prevalence of bacteremia and characteristic of bacterial species in patients with acute pancreatitis. We demonstrate an association between the bacteremia and the disease severity, which enables us to better understand a potential role of bacterial translocation in the pathogenesis of septic complication in acute pancreatitis.
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Critical care medicine · Jun 2013
Review Meta AnalysisThe effect of selenium therapy on mortality in patients with sepsis syndrome: a systematic review and meta-analysis of randomized controlled trials.
Patients with sepsis syndrome commonly have low serum selenium levels. Several randomized controlled trials have examined the efficacy of selenium supplementation on mortality in patients with sepsis. ⋯ In patients with sepsis, selenium supplementation at doses higher than daily requirement may reduce mortality. We observed no impact of selenium on ICU length of stay or risk of nosocomial pneumonia.