Critical care medicine
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Critical care medicine · Jul 2023
State-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist.
To provide a concise review of knowledge and practice pertaining to the diagnosis and initial management of unanticipated adult patient disorders of consciousness (DoC) by the general intensivist. ⋯ Acute adult DoC may be initially comprehensively addressed by the general intensivist using an etiology-driven and team-based approach. Certain clinical conditions, procedural expertise needs, or resource limitations inform transfer decision-making within a complex care facility or to one with greater complexity. Emerging collaborative science helps improve our current knowledge of acute DoC to better align therapies with underpinning etiologies.
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Critical care medicine · Jul 2023
Meta AnalysisPredictors of Noninvasive Ventilation Failure in the Post-Extubation Period: A Systematic Review and Meta-Analysis.
To identify factors associated with failure of noninvasive ventilation (NIV) in the post-extubation period. ⋯ We identified several prognostic factors before and 1 hour after NIV initiation associated with increased risk of NIV failure in the post-extubation period. Well-designed prospective studies are required to confirm the prognostic importance of these factors to help further guide clinical decision-making.
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Critical care medicine · Jul 2023
Multicenter StudyDevelopment and External Validation of the International Early Warning Score for Improved Age and Sex Adjusted In-Hospital Mortality Prediction in the Emergency Department.
Early Warning Scores (EWSs) have a great potential to assist clinical decision-making in the emergency department (ED). However, many EWS contain methodological weaknesses in development and validation and have poor predictive performance in older patients. The aim of this study was to develop and externally validate an International Early Warning Score (IEWS) based on a recalibrated National Early warning Score (NEWS) model including age and sex and evaluate its performance independently at arrival to the ED in three age categories (18-65, 66-80, > 80 yr). ⋯ The IEWS substantially improves in-hospital mortality prediction for all ED patients greater than or equal to18 years.