Articles: critical-illness.
-
Journal of critical care · Oct 2022
ReviewPitfalls and pearls with drug dosing in the critically ill obese patient: 10 statements to guide ICU practitioners.
Obesity is highly prevalent in ICU patients presenting a number of challenges, one of which is drug dosing. There are limited high-quality data describing drug dosing in obesity, which can lead to dosing strategies that are suboptimal. ⋯ A generalized framework for decision making specific for obese patients is available that describes a step-by-step approach for constructing dosing regimens. This manuscript will build on that framework by providing pitfalls and pearls for clinicians to consider when making dosing decisions in critically ill patients with severe obesity.
-
Am. J. Respir. Crit. Care Med. · Oct 2022
Observational StudyLung Microbiota of Critically Ill COVID-19 Patients are Associated with Non-Resolving Acute Respiratory Distress Syndrome.
Rationale: Bacterial lung microbiota are correlated with lung inflammation and acute respiratory distress syndrome (ARDS) and altered in severe coronavirus disease (COVID-19). However, the association between lung microbiota (including fungi) and resolution of ARDS in COVID-19 remains unclear. We hypothesized that increased lung bacterial and fungal burdens are related to nonresolving ARDS and mortality in COVID-19. ⋯ Lung microbiota composition was associated with successful extubation (P = 0.0045). Proinflammatory cytokines (e.g., tumor necrosis factor-α) were associated with the microbial burdens. Conclusions: Bacterial and fungal lung microbiota are related to nonresolving ARDS in COVID-19 and represent an important contributor to heterogeneity in COVID-19-related ARDS.
-
Critical care clinics · Oct 2022
ReviewLiving on the Edge of Possibility: Ethical Issues in the Care of Critically Ill Patients in Resource-Limited Settings.
The birth, expansion, and sustenance of critical care medicine as a specialty have often presented ethical challenges and dilemmas to health care workers in diverse settings. In addition to critical services being provided at the extreme end of a disease process, they are often in limited supply. The authors present patterns of inception and development of this crucial service as they have witnessed in rural Africa. Furthermore, they present the ethical challenges, both typical and unique, as they have experienced them in a tertiary referral center in Kenya.
-
The aim of this study was to provide reference for improving the quality of future guidelines by evaluating present guidelines for nutrition in critically ill adults using Report Items for Practice Guidelines in Healthcare (RIGHT) and Appraisal of Guidelines for Research and Evaluation (AGREE II). ⋯ Report and methodological quality of guidelines for nutrition in critically ill adults were relatively high. The evaluation results of RIGHT and AGREE II are consistent, with higher scores in the field of background and lower scores in the part on quality control and applicability. To facilitate application of guidelines, RIGHT and AGREE II should be used as criteria by guideline developers.
-
During the first wave of the COVID-19 pandemic, restricted visitation policies were enacted at acute care facilities to reduce the spread of COVID-19 and conserve personal protective equipment. In this study, we aimed to describe the impact of restricted visitation policies on critically ill patients, families, critical care clinicians, and decision-makers; highlight the challenges faced in translating these policies into practice; and delineate strategies to mitigate their effects. ⋯ Restricted visitation policies across ICUs during the COVID-19 pandemic negatively affected critically ill patients and their families, critical care clinicians, and decision-makers.