Critical care medicine
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Critical care medicine · Apr 2014
Impact of Nurse-Led Remote Screening and Prompting for Evidence-Based Practices in the ICU.
Evidence-based practices are not consistently applied in the ICU. We sought to determine if nurse-led remote screening and prompting for evidence-based practices using an electronic health record could impact ICU care delivery and outcomes in an academic medical center. ⋯ A program by which nurses screened ICU patients for best practices from a remote location was associated with improvements in the quality of care and reductions in duration of mechanical ventilation and length of stay, but had no impact on mortality.
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Critical care medicine · Apr 2014
Multicenter StudyThe Association of Red Cell Distribution Width at Hospital Discharge and Out-of-Hospital Mortality Following Critical Illness.
Red cell distribution width is associated with mortality and bloodstream infection risk in the critically ill. In hospitalized patients with critical illness, it is not known if red cell distribution width can predict subsequent risk of all-cause mortality following hospital discharge. We hypothesized that an increase in red cell distribution width at hospital discharge in patients who survived to discharge following critical care would be associated with increased postdischarge mortality. ⋯ In patients treated with critical care who survive hospitalization, an elevated red cell distribution width at the time of discharge is a robust predictor of subsequent all-cause patient mortality. Increased discharge red cell distribution width likely reflects the presence of proinflammatory state, oxidative stress, arterial underfilling, or a combination, thereof which may explain the observed impact on patient survival following discharge. Elevated red cell distribution width at hospital discharge may identify ICU survivors who are at risk for adverse outcomes following hospital discharge.
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Critical care medicine · Apr 2014
Immunological Characterization of Compensatory Anti-Inflammatory Response Syndrome in Patients With Severe Sepsis: A Longitudinal Study.
To perform a complete immunological characterization of compensatory anti-inflammatory response syndrome in patients with sepsis and to explore the relationship between these changes and clinical outcomes of 28-day mortality and secondary infections. ⋯ We found no evidence to support a two-phase model of sepsis pathophysiology. However, immunological variables did behave in a mixed and time-dependent manner. Further studies should evaluate changes over time of interleukin-6 plasma levels as a prognostic biomarker for critically ill patients.
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Critical care medicine · Apr 2014
Use of Intensive Care Services and Associated Hospital Mortality After Massachusetts Healthcare Reform.
To use the natural experiment of health insurance reform in Massachusetts to study the impact of increased insurance coverage on ICU utilization and mortality. ⋯ Massachusetts healthcare reform increased the number of ICU patients with insurance but was not associated with significant changes in ICU use or discharge destination among ICU patients. Reform was also not associated with changed in-hospital mortality for ICU patients; however, this association was dependent on the comparison states chosen in the analysis.
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Critical care medicine · Apr 2014
An International Career Development Survey of Critical Care Practitioners.
To understand the career development needs of an international multidisciplinary group of critical care practitioners in the 21st century. ⋯ This is the largest assessment of the international critical care community regarding the career development needs of 21st century critical care practitioner although the limited response rate makes this work prone to sampling bias. Career development issues are broad and in need of further development by the Society of Critical Care Medicine In-Training Section. Although these initiatives need improved marketing, the Society of Critical Care Medicine membership is willing to help support them and work to further shape them in the future.