Critical care medicine
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Critical care medicine · Dec 2016
Prognostic Impact of Persistent Thrombocytopenia During Extracorporeal Membrane Oxygenation: A Retrospective Analysis of Prospectively Collected Data From a Cohort of Patients With Left Ventricular Dysfunction After Cardiac Surgery.
The prognostic impact of thrombocytopenia in patients supported by extracorporeal membrane oxygenation after cardiac surgery is uncertain. We investigated whether thrombocytopenia is independently predictive of poor outcome and describe the incidence and time course of thrombocytopenia in extracorporeal membrane oxygenation patients. ⋯ Thrombocytopenia is an independent risk factor for poor outcome in extracorporeal membrane oxygenation patients after cardiac surgery, with persistent severe thrombocytopenia likely reflecting a high degree of physiologic imbalance.
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Critical care medicine · Dec 2016
Dimensions and Role-Specific Mediators of Surrogate Trust in the ICU.
In the ICU, discussions between clinicians and surrogate decision makers are often accompanied by conflict about a patient's prognosis or care plan. Trust plays a role in limiting conflict, but little is known about the determinants of trust in the ICU. We sought to identify the dimensions of trust and clinician behaviors conducive to trust formation in the ICU. ⋯ Interventions to improve trust in the ICU should be role-specific, since surrogate expectations are different for physicians and nurses with regard to behaviors relevant to trust. Further research is needed to confirm our findings and explore the impact of trust modification on clinician-family conflict.
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Critical care medicine · Dec 2016
Incidence and Characteristics of Ventilator-Associated Events Reported to the National Healthcare Safety Network in 2014.
Ventilator-associated event surveillance was introduced in the National Healthcare Safety Network in 2013, replacing surveillance for ventilator-associated pneumonia in adult inpatient locations. We determined incidence rates and characteristics of ventilator-associated events reported to the National Healthcare Safety Network. ⋯ We found substantial variability in ventilator-associated event incidence, proportions of ventilator-associated events characterized as infection-related, and ventilator utilization within and among location types. More work is needed to understand the preventable fraction of ventilator-associated events and identify patient care strategies that reduce ventilator-associated events.
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To determine the costs associated with delirium in critically ill children. ⋯ Pediatric delirium is associated with a major increase in PICU costs. Further research directed at prevention and treatment of pediatric delirium is essential to improve outcomes in this population and could lead to substantial healthcare savings.