Critical care medicine
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Critical care medicine · Jun 2024
Observational StudyHospital Variation in Epinephrine Administration Before Defibrillation for Cardiac Arrest Due to Shockable Rhythm.
Contrary to advanced cardiac life support guidelines that recommend immediate defibrillation for shockable in-hospital cardiac arrest (IHCA), epinephrine administration before first defibrillation is common and associated with lower survival at a "patient-level." Whether this practice varies across hospitals and its association with "hospital-level" IHCA survival remains unknown. The purpose of this study was to determine hospital variation in rates of epinephrine administration before defibrillation for shockable IHCA and its association with IHCA survival. ⋯ Administration of epinephrine before defibrillation in shockable IHCA is common and varies markedly across U.S. hospitals. Hospital rates of epinephrine administration before defibrillation were associated with a significant stepwise decrease in hospital rates of risk-adjusted survival. Efforts to prioritize immediate defibrillation for patients with shockable IHCA and avoid early epinephrine administration are urgently needed.
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Critical care medicine · Jun 2024
Observational StudyBarriers and Facilitators to End-of-Life Care Delivery in ICUs: A Qualitative Study.
To understand frontline ICU clinician's perceptions of end-of-life care delivery in the ICU. ⋯ Standardized work system communication tasks may improve end-of life discussion processes between clinicians and families.
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Critical care medicine · Jun 2024
Meta Analysis Comparative StudyComparison of Different Treatments of Persistent Pulmonary Hypertension of the Newborn: A Systematic Review and Network Meta-Analysis.
Persistent pulmonary hypertension of the newborn (PPHN) is a life-threatening disease. Despite being considered the gold standard treatment scheme, inhaled nitric oxide (iNO) is not readily available in settings with limited resources. Therefore, in recent years, research on related drugs is being actively pursued. Herein, we aimed to use random-effects network meta-analysis to evaluate the efficacy and associated mortality of different PPHN therapies. ⋯ MNO + OSID is the most effective PPHN treatment. If iNO is not available, OSID + milrinone is preferred.
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Critical care medicine · Jun 2024
Multicenter Study Observational StudyIntubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study.
To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices. ⋯ In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.
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Critical care medicine · Jun 2024
Randomized Controlled TrialEffects of Vibration Therapy on the Physical Function of Critically Ill Adults Trial: A Randomized Controlled Trial.
Vibration therapy uses vibration to rehabilitate physical functions. Recently, it has been demonstrated to be safe for critically ill patients. However, its effects on physical functions are unclear. ⋯ Vibration therapy did not improve the total FSS-ICU. However, the supine-to-sit ability in the FSS-ICU improved without any adverse event.