Aust Crit Care
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The cardiovascular risk profile and postoperative morbidity outcomes of anxiety disorder patients undergoing coronary artery bypass surgery is not known. ⋯ A differential cardiovascular risk profile and postoperative outcome was observed dependent on anxiety and depression disorder status. There were few modifiable cardiovascular risk factors at the time of surgery other than psychiatric status, perioperative management of depression and anxiety may have promise to reduce further cardiac morbidity after coronary artery bypass surgery.
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Observational Study
Expert clinical reasoning and pain assessment in mechanically ventilated patients: A descriptive study.
Pain assessment in mechanically ventilated patients is challenging, because nurses need to decode pain behaviour, interpret pain scores, and make appropriate decisions. This clinical reasoning process is inherent to advanced nursing practice, but is poorly understood. A better understanding of this process could contribute to improved pain assessment and management. ⋯ Patient's clinical condition is important for making decision about pain in critically ill nonverbal patients. The concept of pain cannot be assessed in isolation and its assessment should take the patient's clinical stability and sedation into account. Further research is warranted to confirm these results.
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To explore the association between patient volume in intensive care units (ICUs) and risk-adjusted mortality. ⋯ Patient mortality may be improved in large capacity ICUs. However, the association is not consistent across all diagnostic groups. Risk adjusted mortality is increased in low volume ICUs. There appears to be a high volume threshold at which point the risk adjusted mortality benefit is also lost suggesting a window of optimal ICU organisational performance exists between low and high volumes. Further prospective research is recommended into clinical outcomes in high volume ICUs to explore association between organisational efficiency and quality of care.
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Randomized Controlled Trial
Incidence of aspiration and gastrointestinal complications in critically ill patients using continuous versus bolus infusion of enteral nutrition: a pseudo-randomised controlled trial.
Enteral nutrition (EN) for the critically ill and mechanically ventilated patients can be administered either via the continuous or bolus methods. However, there is insufficient evidence supporting which of these methods may have a lower risk of aspiration and gastrointestinal (GI) complications. This study was conducted in order to identify the incidence of aspiration and GI complications using continuous enteral nutrition (CEN) and bolus enteral nutrition (BEN) in critically ill patients at the Rafik Hariri University Hospital (RHUH), Beirut, Lebanon. ⋯ CEN versus BEN methods did not affect the incidence of aspiration, HGRV, vomiting or diarrhoea. However, the incidence of constipation was significantly greater in patients receiving CEN.
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Multicenter Study
Exploring Australian intensive care physicians clinical judgement during Donation after Cardiac Death: an exploratory qualitative study.
Donation after Cardiac Death (DCD) is one possible solution to the world wide organ shortage. Intensive care physicians are central to DCD becoming successful since they are responsible for making the clinical judgements and decisions associated with DCD. Yet international evidence shows health care professionals have not embraced DCD and are often reluctant to consider it as an option for patients. ⋯ DCD decisions are made within an environment of uncertainty due to the imprecision associated with predicting time of death. Lack of certainty contributed to the cautious and collaborative strategies used by intensive care physicians when dealing with patients, family members and colleagues around end-of-life decisions, initiation of withdrawal of life-sustaining treatment and the discussion about DCD. This study recommends that nationally consistent policies are urgently needed to increase the degree of certainty for intensive care staff concerning the DCD processes.