Articles: intensive-care-units.
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Critical care clinics · Jul 2023
ReviewFour Decades of Intensive Care Unit Design Evolution and Thoughts for the Future.
Intensive care unit (ICU) design has changed since the mid-1980s. Targeting timing and incorporation of the dynamic and evolutionary processes inherent in ICU design is not possible nationally. ICU design will continue evolving to incorporate new concepts of best design evidence and practice, better understandings of the needs of patients, visitors and staff, unremitting advances in diagnostic and therapeutic approaches, ICU technologies and informatics, and the ongoing search to best fit ICUs within greater hospital complexes. As the ideal ICU remains a moving target; the design process should include the ability for an ICU to evolve into the future.
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Am. J. Respir. Crit. Care Med. · Jul 2023
Randomized Controlled TrialStructured Mobilization for Critically Ill Patients: A Pragmatic Cluster-Randomized Trial.
Rationale: Small trials and professional recommendations support mobilization interventions to improve recovery among critically ill patients, but their real-world effectiveness is unknown. Objective: To evaluate a low-cost, multifaceted mobilization intervention. Methods: We conducted a stepped-wedge cluster-randomized trial across 12 ICUs with diverse case mixes. ⋯ ICU mortality (31.5% vs. 29.0%), falls (0.7% vs. 0.4%), and unplanned extubations (2.0% vs. 1.8%) were similar between groups (all P > 0.3). Conclusions: A low-cost, multifaceted mobilization intervention did not improve overall mobility but improved patients' odds of standing and was safe. Clinical trial registered with www.clinicaltrials.gov (NCT03863470).
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Intensive care medicine · Jul 2023
Multicenter Study Observational StudyRelationship between COVID-19 and ICU-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter before-after study.
Patients presenting the most severe form of coronavirus disease 2019 (COVID-19) pneumonia, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have a prolonged intensive care unit (ICU) stay and are exposed to broad-spectrum antibiotics, but the impact of COVID-19 on antimicrobial resistance is unknown. ⋯ COVID-19 patients had an increased incidence of ICU-MDR-inf compared to controls, but the difference was not significant when considering a composite outcome including ICU-MDR-col and/or ICU-MDR-inf.
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Critical care clinics · Jul 2023
ReviewCritical Care 1950 to 2022: Evolution of Medicine, Nursing, Technology, and Design.
Critical care units-designed for concentrated and specialized care-came from multiple parallel advances in medical, surgical, and nursing techniques and training taking advantage of new therapeutic technologies. Regulatory requirements and government policy impacted design and practice. ⋯ Hospitals offered newer, more extreme, and specialized surgeries and anesthesia enabled more complex procedures. ICUs developed in the 1950s, providing a recovery room's level of observation and specialized nursing to serve the critically ill, whether medical or surgical.
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Critical care pharmacy has evolved rapidly over the last 50 years to keep pace with the rapid technological and knowledge advances that have characterized critical care medicine. The modern-day critical care pharmacist is a highly trained individual well suited for the interprofessional team-based care that critical illness necessitates. Critical care pharmacists improve patient-centered outcomes and reduce health care costs through three domains: direct patient care, indirect patient care, and professional service. Optimizing workload of critical care pharmacists, similar to the professions of medicine and nursing, is a key next step for using evidence-based medicine to improve patient-centered outcomes.