Current opinion in critical care
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The quality of cardiopulmonary resuscitation (CPR) impacts on outcome after cardiac arrest. This review will explore the factors that contribute to high-quality CPR and the metrics that can be used to monitor performance. ⋯ There is evidence for increasing survival rates following out-of-hospital cardiac arrest and this is associated with increasing rates of bystander CPR. The quality of CPR provided by healthcare professionals can be improved with real-time feedback devices. The components of high-quality CPR and the metrics that can be measured and fed back to healthcare professionals have been defined by expert consensus. In the future, real-time feedback based on the physiological responses to CPR may prove more effective.
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Curr Opin Crit Care · Apr 2014
ReviewFeeding the gut: how, when and with what - the metabolic issue.
To review the literature on feeding critically ill patients with special emphasis on the intestine. ⋯ The use of gastric feeding in critical illness is recommended. Successful gastric feeding is indicative of a functional gastrointestinal tract. Pharmacological effects of nutrients are questionable, but supplementation of deficits (glutamine, selenium, etc.) may be in the patient's best interest. A more individualized prescription of nutrition in the critically ill is advocated.
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Curr Opin Crit Care · Apr 2014
ReviewNursing collaboration: a key element in debunking neurocritical care myths.
To explore the origin of myths and their progression toward dogma. The process of debunking myths in the neurocritical care unit (NCCU) is facilitated if nurses are involved early during the process. ⋯ Myth and dogma are problems confronted in all of medicine and here we provide specific examples from the NCCU. Nursing care, especially in the ICU, can help identify these myths and, in conjunction with physicians, tests these myths via the scientific method instead of accepting the null hypothesis. Even when myths are proven false, changing clinical practice, altering physician or nurse behavior, and fighting dogma remain a challenge.
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The care of critically ill brain-injured patients is complex and requires careful balancing of cerebral and systemic treatment priorities. A growing number of studies have reported improved outcomes when patients are admitted to dedicated neurocritical care units (NCCUs). The reasons for this observation have not been definitively clarified. ⋯ Neurocritical care is an evolving field that is associated with improvements in outcomes over the past decade. Further research is required to determine how monitoring and treatment protocols can be optimized.