Articles: intensive-care-units.
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Intensive care medicine · Oct 2022
ReviewPlasma exchange in the intensive care unit: a narrative review.
In this narrative review, we discuss the relevant issues of therapeutic plasma exchange (TPE) in critically ill patients. For many conditions, the optimal indication, device type, frequency, duration, type of replacement fluid and criteria for stopping TPE are uncertain. ⋯ In the intensive care unit (ICU), the indications for TPE can be divided into (1) absolute, well-established, and evidence-based, for which TPE is recognized as first-line therapy, (2) relative, for which TPE is a recognized second-line treatment (alone or combined) and (3) rescue therapy, where TPE is used with a limited or theoretical evidence base. New indications are emerging and ongoing knowledge gaps, notably regarding the use of TPE during critical illness, support the establishment of a TPE registry dedicated to intensive care medicine.
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Delirium in critically ill children is associated with increased in-hospital morbidity and mortality. Little is known about the lingering effects of pediatric delirium in survivors after hospital discharge. The primary objective of this study was to determine whether children with delirium would have a higher likelihood of all-cause PICU readmission within 1 calendar year, when compared with children without delirium. ⋯ In this cohort, delirium duration was an independent risk factor for readmission in critically ill children. Future research is needed to determine if decreasing prevalence of delirium during hospitalization can decrease need for PICU readmission.
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Intensive care medicine · Oct 2022
ReviewMachines that save lives in the intensive care unit: the ultrasonography machine.
This article highlights the ultrasonography machine as a machine that saves lives in the intensive care unit. We review its utility in the limited resource intensive care unit and some elements of machine design that are relevant to both the constrained operating environment and the well-resourced intensive care unit. As the ultrasonography machine can only save lives, if is operated by a competent intensivist; we discuss the challenges of training the frontline clinician to become competent in critical care ultrasonography followed by a review of research that supports its use.
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Pediatr Crit Care Me · Oct 2022
Functional Status and Hospital Readmission After Pediatric Critical Disease: A Year Follow-Up.
To evaluate the association between pediatric functional status at hospital discharge after PICU admission and hospital readmission within 1 year. ⋯ FSS-Brazil rating at hospital discharge, age, and length of stay were associated with greater hazard of nonelective hospital readmission within 1 year of discharge.
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Pediatr Crit Care Me · Oct 2022
Lessons and Insights From the Implementation of the Cohort Model for a PICU: A Case Study Research.
The subspecialty cohort model allows for creation of smaller diagnosis pools, enabling concentration of expertise and collaboration. Given unknown effects of this model on team dynamics in a PICU, we examined how the cohort-model implementation was perceived by our providers and how this organizational change affected the work environment. ⋯ Our transition to a cohort PICU model offers lessons on impacts of PICU model changes on communities and teams. These theory-informed insights and implications can guide others undergoing similar transitions.