Articles: critical-illness.
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Critical care medicine · Jun 2023
Routine Versus On-Demand Blood Sampling in Critically Ill Patients: A Systematic Review.
We aimed to provide an overview of the current evidence on routine versus on-demand blood sampling in critical care. We assessed the reported proportion of patients exposed to daily routine blood sampling, the tests performed, characteristics associated with more frequent blood sampling, and the reported benefits and harms of routine blood sampling compared with on-demand sampling. ⋯ In this systematic review, routine blood testing in critically ill patients was common and varied considerably. A reduction in routine blood testing appeared to be associated with reduced transfusion rates and costs without adverse effects, but the evidence was very uncertain.
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Observational Study
The Pediatric Bougie for the First Tracheal Intubation Attempt in Critically Ill Children.
Bougie use during emergency tracheal intubation has not been well studied in children. ⋯ In an academic ED where the bougie is commonly used, bougie use in children was not associated with procedural success or complications. Our study suggests that a randomized clinical trial is needed to determine the effect of bougie use during emergency pediatric intubation.
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Pediatr Crit Care Me · Jun 2023
Observational StudyStructured Multidisciplinary Follow-Up After Pediatric Intensive Care: A Model for Continuous Data-Driven Health Care Innovation.
Morbidity after PICU admission for critical illness is a growing concern. Sequelae may occur in various domains of functioning and can only appropriately be determined through structured follow-up. Here, we describe the process of designing and implementing a structured multidisciplinary follow-up program for patients and their parents after PICU admission and show the first results illustrating the significance of our program. ⋯ We successfully developed and implemented a structured multidisciplinary follow-up program for patients and their parents after PICU admission. This program may help to timely initiate appropriate interventions, improve the standard of care during and after PICU admission, and facilitate scientific research on outcome and prognosis after PICU admission.
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Critical care medicine · Jun 2023
Multicenter Study Observational StudyRecognition of Critically Ill Patients by Acute Health Care Providers: A Multicenter Observational Study.
Although the Modified Early Warning Score (MEWS) is increasingly being used in the acute care chain to recognize disease severity, its superiority compared with clinical gestalt remains unproven. Therefore, the aim of this study was to compare the accuracy of medical caregivers and MEWS in predicting the development of critical illness. ⋯ For patients admitted to the ED by EMS, medical professionals can predict the development of critical illness within 3 days significantly better than the MEWS. Although MEWS is able to correctly predict those patients that become critically ill, its use leads to overestimation due to a substantial number of false positives.
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Curr Opin Crit Care · Jun 2023
ReviewPulse wave analysis: basic concepts and clinical application in intensive care medicine.
The measurement of cardiac output ( CO ) is important in patients with circulatory shock. Pulse wave analysis (PWA) estimates CO continuously and in real-time using the mathematical analysis of the arterial pressure waveform. We describe different PWA methods and provide a framework for CO monitoring using PWA in critically ill patients. ⋯ Noninvasive PWA methods are generally not recommended in critically ill patients (who have arterial catheters anyway). PWA systems can be used to continuously track stroke volume and CO in real-time during tests of fluid responsiveness or during therapeutic interventions. During fluid challenges, continuous CO monitoring is important because - if CO decreases - a fluid challenge can be stopped early to avoid further unnecessary fluid administration. PWA externally calibrated to indicator dilution methods can be used - in addition to echocardiography - to diagnose the type of shock.