Critical care medicine
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Critical care medicine · May 2015
Autonomic Nervous System Activity as Risk Predictor in the Medical Emergency Department: A Prospective Cohort Study.
To evaluate heart rate deceleration capacity, an electrocardiogram-based marker of autonomic nervous system activity, as risk predictor in a medical emergency department and to test its incremental predictive value to the modified early warning score. ⋯ Deceleration capacity is a strong and independent predictor of short-term mortality among patients admitted to a medical emergency department.
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Critical care medicine · May 2015
Multicenter StudyLong-Term Association Between Frailty and Health-Related Quality-of-Life Among Survivors of Critical Illness: A Prospective Multicenter Cohort Study.
Frailty is a multidimensional syndrome characterized by loss of physiologic reserve that gives rise to vulnerability to poor outcomes. We aimed to examine the association between frailty and long-term health-related quality of life among survivors of critical illness. ⋯ Frail survivors of critical illness experienced greater impairment in health-related quality of life, functional dependence, and disability compared with those not frail. The systematic assessment of frailty may assist in better informing patients and families on the complexities of survivorship and recovery.
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Critical care medicine · May 2015
Review Meta AnalysisPosttraumatic Stress Disorder in Critical Illness Survivors: A Metaanalysis.
To conduct a systematic review and metaanalysis of the prevalence, risk factors, and prevention/treatment strategies for posttraumatic stress disorder symptoms in critical illness survivors. ⋯ Clinically important posttraumatic stress disorder symptoms occurred in one fifth of critical illness survivors at 1-year follow-up, with higher prevalence in those who had comorbid psychopathology, received benzodiazepines, and had early memories of frightening ICU experiences. In European studies, ICU diaries reduced posttraumatic stress disorder symptoms.
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Critical care medicine · May 2015
Multicenter StudyExtracorporeal Membrane Oxygenation for the Support of Adults With Acute Myocarditis.
To characterize survival outcomes for adult patients with acute myocarditis supported with extracorporeal membrane oxygenation and identify risk factors for in-hospital mortality. ⋯ Extracorporeal membrane oxygenation can be used effectively in adults with myocarditis to support the circulation while awaiting myocardial recovery. Early extracorporeal membrane oxygenation deployment prior to cardiac arrest may be associated with better outcomes.
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Critical care medicine · May 2015
ReviewThe Formation, Elements of Success, and Challenges in Managing a Critical Care Program (Part II).
Leaders of critical care services require knowledge and skills not typically acquired during their medical education and training. Leaders possess personality characteristics and evolve and adopt behaviors and knowledge in addition to those useful in the care of patients and rounding with an ICU team. Successful leaders have impeccable integrity, possess a service mentality, are decisive, and speak the truth consistently and accurately. ⋯ Clinician compensation must be commensurate with expectations and be written to motivate and make clear duties that are clinical and nonclinical. A leader understands and plans to address the evolving challenges facing healthcare, especially resource constraints, the emotions and requirements of managing the end of life, the complexities of competing demands and motivations, the bureaucracy of healthcare practice, and reimbursement. Responsibilities to manage and evolve must be met with intelligence, sensitivity, and equanimity.