Crit Care Resusc
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Multicenter Study Comparative Study
Severe sepsis and septic shock in patients with pre-existing non-cardiac pulmonary hypertension: contemporary management and outcomes.
To review treatment and outcomes of septic shock in patients with pulmonary hypertension (PH) managed at a tertiary care institution. ⋯ The severity of PH, new-onset AF, and longer vasopressor support were associated with poor outcomes in patients with PH who developed severe sepsis and septic shock.
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Review
Treatment goals: health care improvement through setting and measuring patient-centred outcomes.
To determine how frequently stress ulcer prophylaxis (SUP) medications prescribed in the intensive care unit are inappropriately continued on the ward and on hospital discharge. ⋯ SUP medications commenced in ICU are frequently continued unnecessarily, both in the wards and on hospital discharge.
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Multicenter Study Comparative Study
Inappropriate continuation of stress ulcer prophylaxis beyond the intensive care setting.
To determine how frequently stress ulcer prophylaxis (SUP) medications prescribed in the intensive care unit are inappropriately continued on the ward and on hospital discharge. ⋯ SUP medications commenced in ICU are frequently continued unnecessarily, both in the wards and hospital discharge.
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Comparative Study
Fluid balance does not predict estimated sodium balance in critically ill mechanically ventilated patients.
Distribution of total body water (TBW) depends on local and systemic factors including osmolality, relative sodium content and permeability. Although positive fluid balance has been associated with increased morbidity and mortality in critically ill patients, the mechanisms and relative roles of sodium balance and water distribution are uncertain. ⋯ Fluid balance may not reflect sodium balance in critically ill patients. As sodium balance correlates with respiratory dysfunction and increased extracellular volume, further studies examining sodium balance and morbidity seem warranted.
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Comparative Study
Improving communication of the daily care plan in a teaching hospital intensive care unit.
Patients admitted to intensive care units have complex care needs. Accordingly, communication and handover of the medical care plan is very important. ⋯ Introduction of a single-page, handwritten, structured daily care plan produced marked improvements in ICU nurses' self-reported understanding of elements of the medical plan, and may have reduced practice variation in medical plan documentation. The effects of this intervention on patient outcomes remain untested.