Critical care medicine
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Critical care medicine · Apr 2015
Septic Shock Sera Containing Circulating Histones Induce Dendritic Cell-Regulated Necrosis in Fatal Septic Shock Patients.
Innate immune system alterations, including dendritic cell loss, have been reproducibly observed in patients with septic shock and correlated to adverse outcomes or nosocomial infections. The goal of this study is to better understand the mechanisms behind this observation in order to better assess septic shock pathogenesis. ⋯ The study demonstrates a differential mechanism of dendritic cell death in patients with septic shock that is dependent on the severity of the disease.
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Critical care medicine · Apr 2015
A Qualitative Study Exploring Moral Distress in the ICU Team: The Importance of Unit Functionality and Intrateam Dynamics.
Our study objectives were to determine the key sources of moral distress in diverse critical care professionals and how they manage it in the context of team-based models. ⋯ This study identified the ways in which moral distress manifests across critical care disciplines in different ICU environments. Our results have potential implications for patient care. First, when clinicians alter the content of their goals-of-care conversations with patients or families to accommodate intrateam discordance (as part of the "pas-de-deux"), subsequent decisions regarding medical care may be compromised. Second, when different team members respond differently to the same case-with nurses becoming more emotionally invested and physicians becoming more withdrawn-communication gaps are likely to occur at critical moral distress junctures. Finally, our findings suggest that physicians and any healthcare professionals in surgical units might be susceptible to unmitigated moral distress because they report less engagement in constructive behaviors to recalibrate their distress.
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Critical care medicine · Apr 2015
The Formation, Elements of Success, and Challenges in Managing a Critical Care Program: Part I.
Leaders of critical care programs have significant responsibility to develop and maintain a system of intensive care. At inception, those clinician resources necessary to provide and be available for the expected range of patient illness and injury and throughput are determined. Simultaneously, non-ICU clinical responsibilities and other expectations, such as education of trainees and participation in hospital operations, must be understood. ⋯ Major emphasis is placed on the importance of continuity, consistency, and communication by expecting practitioners to adopt similar practices and patterns. Services anticipate and adapt to evolving expectations and resource availability. Effective services will result when skilled practitioners support one another and ascribe to a service philosophy of care.