Articles: intensive-care-units.
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Rapid response systems have been advocated as a potential model to identify and intervene in patients who are experiencing deterioration on general hospital wards. ⋯ We found weak evidence that rapid response systems are associated with a reduction in hospital mortality and cardiac arrest rates, but limitations in the quality of the original studies, the wide confidence intervals, and the presence of heterogeneity limited our ability to conclude that rapid response systems are effective interventions. Large randomized controlled trials are needed to clarify the efficacy of rapid response systems before they should become standard of care.
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Ventilator-associated pneumonia (VAP), a frequent nosocomial infection in the intensive care, is associated with considerable morbidity. Endotracheal suctioning is routinely performed in mechanically ventilated patients to clear secretions. This study assessed if there were advantages of closed endotracheal suctioning (CES) over open endotracheal suctioning (OES) with respect to clinical outcomes. ⋯ This meta-analysis has not demonstrated a superiority of CES over OES with respect to VAP or mortality. Thus the decision for the use of CES may be based on possible benefits in patients requiring high respiratory supports, reduced costs in those needing prolonged MV or occupational health and safety concerns with OES.
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Review Meta Analysis
Nurse staffing levels and hospital mortality in critical care settings: literature review and meta-analysis.
This paper reports a review of the literature on the association between critical care nurse staffing levels and patient mortality. ⋯ The impact of nurse staffing levels on patients' hospital mortality in critical care settings was not evident in the reviewed studies. Methodological challenges that might have impeded correct assessment of the association include measurement problems in exposure status and confounding factors, often uncontrolled. The lack of association also indicates that hospital mortality may not be sensitive enough to detect the consequences of low nurse staffing levels in critical care settings.
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Review Meta Analysis
Preliminary evidence for a medical nutrition therapy protocol: enteral feedings for critically ill patients.
The objective of this study was to evaluate the evidence behind specific but common patient care decisions in support of enteral feedings for patients admitted to intensive care units. Six specific questions were developed and refined to address clinical outcomes specific to clinical practice decisions pertinent to enteral feeding of critically ill patients. The data sources consisted of an intensive literature review from five databases, using standardized search terms. ⋯ Actual delivery of 14 to 18 kcal/kg/day or 60% to 70% of goal is associated with improved outcomes, whereas greater intake may not be in some populations. Blue food coloring should not be used with enteral feedings due to its limited sensitivity for aspiration and some risk of mortality. Well-designed, adequately powered, randomized controlled clinical trials are needed to evaluate any benefit of tube tip position on aspiration pneumonia or mortality, and of early enteral feedings on mortality.