Articles: mechanical-ventilation.
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Critical care clinics · Jan 2021
ReviewEvidence-Based Communication with Critically Ill Older Adults.
Communication is a critical component of patient-centered care. Critically ill, mechanically ventilated patients are unable to speak and this condition is frightening, frustrating, and stressful. ⋯ Older adults are at higher risk for communication impairments in the ICU because of pre-illness communication disorders and cognitive dysfunction that often accompanies or precedes critical illness. Assessing communication disorders and developing patient-centered strategies to enhance communication can lessen communication difficulty and increase patient satisfaction.
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Respiratory failure in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears related to cytokine release syndrome that often results in mechanical ventilation (MV). We investigated the role of tocilizumab (TCZ) on interleukin-6 (IL-6) trends and MV in patients with SARS-CoV-2. In this longitudinal observational study, 112 patients were evaluated from 1 February to 31 May 2020. ⋯ Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D-dimer levels. The sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. IL-6 levels may be helpful as a prognostic tool.
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Observational Study
Prone positioning for patients intubated for severe acute respiratory distress syndrome (ARDS) secondary to COVID-19: a retrospective observational cohort study.
The role of repeated prone positioning in intubated subjects with acute respiratory distress syndrome caused by COVID-19 remains unclear. ⋯ Patients with COVID-19 acute respiratory distress syndrome frequently responded to initial prone positioning with improved oxygenation. Subsequent prone positioning in subjects discharged from hospital was associated with greater improvements in oxygenation.
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Anaesth Intensive Care · Jan 2021
The effect of alcohol policy on intensive care unit admission patterns in Central Australia: A before-after cross-sectional study.
Alcohol misuse is a disproportionately large contributor to morbidity and mortality in the Northern Territory. A number of alcohol harm minimisation policies have been implemented in recent years. The effect of these on intensive care unit (ICU) admissions has not been fully explored. ⋯ Admissions with a primary diagnosis of trauma were lower (10.5% versus 4.7%, P < 0.01). This study demonstrated a reduction in ICU admissions associated with alcohol misuse following the implementation of new alcohol harm minimisation policies. This apparent reduction in alcohol-related harm is suggestive of the effectiveness of the Northern Territory's integrated alcohol harm reduction framework.
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Accurate height measurement is critical for accurate dosing of medications, mechanical ventilation, and nutritional calculations. Prior research has identified inaccuracies with self-reported height, and height is notably important to measure accurately in critically ill patients. In this study, conducted in a large tertiary academic medical center, medical records rarely indicated the method of height measurement, and there were statistically significant variations in measured height across admissions.