Articles: critical-illness.
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Critical care medicine · Jan 2025
Multicenter StudyDiabetes Mellitus Is Not a Risk Factor for Difficult Intubation Among Critically Ill Adults: A Secondary Analysis of Multicenter Trials.
Diabetes mellitus has been associated with greater difficulty of tracheal intubation in the operating room. This relationship has not been examined for tracheal intubation of critically ill adults. We examined whether diabetes mellitus was independently associated with the time from induction of anesthesia to intubation of the trachea among critically ill adults. ⋯ Among 2654 critically ill patients undergoing tracheal intubation in an ED or an ICU, diabetes mellitus was not independently associated with the time from induction to intubation, the probability of successful intubation on the first attempt, or the rate of complications during intubation.
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Critical care clinics · Jan 2025
ReviewCreating a Culture of an Awake and Walking Intensive Care Unit: In-Hospital Strategies to Mitigate Post-Intensive Care Syndrome.
The ABCDEF bundle and Awake and Walking intensive care unit (ICU) approach aim to prevent the long-term consequences of critical illness (ie, post-intensive care syndrome) by promoting patient wakefulness, cognition, and mobility. Humanizing the ICU experience is the key, preserving patients' function and autonomy. Successful implementation requires cultivating an ICU culture focused on avoiding sedatives and initiating prompt mobilization, addressing organizational barriers through tailored strategies. Overall, these patient-centered, mobility-focused models offer a holistic solution to the complex challenge of preventing post-intensive care syndrome and supporting critical illness survivors.
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Intensive care unit (ICU) survivors experience longstanding psychological impairments that persist in the months to years following ICU discharge, regardless of severity of illness or extent of physical recovery. Risk factors for psychological problems following critical illness have been identified including early symptoms of acute stress. Assessment of psychological symptoms in ICU patients and survivors remains inconsistent and many do not receive appropriate psychological evaluation, diagnosis, or treatment. Screening patients for psychological impairments early and serially following hospitalization is crucial to addressing patients' needs and mitigating long-term distress, as is connecting patients to outpatient mental health follow-up for treatment.
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Acta Anaesthesiol Scand · Jan 2025
Accuracy of estimating equations for the assessment of glomerular filtration rate in critically ill patients versus outpatients.
Estimating equations for the assessment of glomerular filtration rate (GFR) have been poorly investigated in the critical care setting. We evaluated the agreement between the GFR measured with 51CrEDTA/iohexol (mGFR) and four estimating equations based on serum concentrations of creatine and/or cystatin C (eGFR) in two cohorts: critically ill patients and outpatients with normal-to-moderately reduced GFR. ⋯ For the assessment of glomerular filtration rate (GFR), it can be measured directly, but is frequently estimated using a point measure of serum creatinine concentration. In this study, ICU case GFR estimations, by different adjusted equations, done also for a cohort of outpatients, showed that these serum creatinine-based estimations for ICU cases are not highly precise or reliable.
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Acta Anaesthesiol Scand · Jan 2025
Comparative StudyComparison of venous and calculated blood gas values to arterial values in critically ill patients.
Arterial blood gas (ABG) values are important in the assessment of critically ill patients. However, arterial puncture may be challenging to perform in these patients. The venous-to-arterial conversion method (v-TAC) is used to convert venous blood gas values to calculated values meant to resemble arterial values. Calculated pH and partial pressure of carbon dioxide (PCO2) values have shown good agreement with arterial values in stable patients, but performance of the method in patients with severe acid-base disturbances is unknown. We aim to evaluate venous and calculated blood gas value congruency with arterial values in critically ill patients. ⋯ Venous and calculated pH and PCO2 values showed similar congruency with arterial values in patients with alkalemia and moderate acidaemia, while the method was unreliable in a patient suspected of severe metabolic acidaemia.