Critical care medicine
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Critical care medicine · Jul 2023
Observational StudyAssociation of Sublingual Microcirculation Parameters and Capillary Refill Time in the Early Phase of ICU Admission.
This observational study was conducted to investigate capillary refill time (CRT) during the early phase of ICU admission in relationship with microvascular flow alteration and outcome in critically ill patients. ⋯ In our ICU population, a single-spot prolonged CRT was independently associated with abnormal microcirculation and increased mortality.
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Critical care medicine · Jul 2023
Do They Have a Choice? Surrogate Decision-Making After Severe Acute Brain Injury.
In the early phase of severe acute brain injury (SABI), surrogate decision-makers must make treatment decisions in the face of prognostic uncertainty. Evidence-based strategies to communicate uncertainty and support decision-making are lacking. Our objective was to better understand surrogate experiences and needs during the period of active decision-making in SABI, to inform interventions to support SABI patients and families and improve clinician-surrogate communication. ⋯ In this qualitative study, not all surrogate "decision-makers" viewed themselves as making decisions. Nearly all struggled with prognostic uncertainty. Our findings underline the need for longitudinal prognostic communication strategies in SABI targeted at surrogates' current perspectives on decision-making.
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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.