Current opinion in critical care
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Curr Opin Crit Care · Oct 2013
ReviewPrompting physicians to address a daily checklist for antibiotics: do we need a co-pilot in the ICU?
Failed opportunities to reduce morbidity and mortality occur when evidence-based therapies are not fully implemented in clinical practice. We reviewed the recent literature on implementation strategies in the intensive care unit, with particular attention to antibiotic therapy. ⋯ Newer implementation strategies focused on real-time, point-of-care interventions have been associated with greater impact. The most common of these new interventions is use of checklists. Greater checklist use has led to the realization that a prompting or forcing function is required for optimal benefit.
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Frailty is a multidimensional syndrome characterized by loss of physiologic reserves that gives rise to vulnerability to adverse events. ⋯ The concept of frailty, as a marker of biologic age and physiologic reserve, may have direct relevance to critical care, and clearly identifies a population at greater risk of adverse events, morbidity, and mortality. Its recognition in critical care settings may enable improved prognostication and shared decision-making and identify vulnerable subgroups with specific needs who might benefit from targeted follow-up.
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Curr Opin Crit Care · Oct 2013
ReviewEvaluation of left ventricular structure and function by three-dimensional echocardiography.
To summarize research on the use of 3-dimensional (3D) echocardiography for quantifying left ventricular (LV) volumes, ejection fraction, and mass, and to describe emerging applications of the technology. ⋯ With real-time 3DTTE, one can acquire and display a 3D image encompassing the entire LV within seconds. Because 3DTTE aids in identification of the true LV apex, it provides more accurate LV volumes than its 2D counterpart. As compared with a cardiovascular magnetic resonance standard, 3DTTE tends to slightly underestimate LV volumes, in part because its spatial resolution is limited, making identification of the true endocardial border more difficult. As compared with 2DTTE, 3DTTE is advantageous for identifying and assessing the extent of regional wall motion abnormalities. For quantification of LV mass, 3DTTE is superior to both 2DTTE and M-mode echocardiography. Emerging applications of 3DTTE include speckle-tracking strain assessment, dyssynchrony analysis, and LV shape analysis, which appear to have prognostic value in patients with a variety of cardiac conditions.
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Curr Opin Crit Care · Oct 2013
ReviewApproaches to decreasing medication and other care errors in the ICU.
The very complex process of intensive care is accompanied by a not unexpected accumulation of risk for error and adverse events. The present review addresses strategies to decrease care errors in several domains of daily intensive care practice. ⋯ The present review discusses recent approaches aimed to decrease care errors in ICUs. A growing body of evidence demonstrates that a system based approach with the change of process characteristics and the development of a safety climate is most essential in the effort to increase patient safety.