Articles: critical-illness.
-
Ann Acad Med Singap · Oct 2022
ReviewNutrition therapy in the older critically ill patients: A scoping review.
There is a lack of guidelines or formal systematic synthesis of evidence for nutrition therapy in older critically ill patients. This study is a scoping review to explore the state of evidence in this population. ⋯ Based on limited evidence, assessment of muscle mass, indirect calorimetry and careful monitoring of urea level may be important to guide nutrition therapy in older ICU patients. Other nutrition recommendations for general ICU patients may be used for older patients with sound clinical discretion.
-
Journal of critical care · Oct 2022
Association of blood pressure variability with short- and long-term cognitive outcomes in patients with critical illness.
Blood pressure variability (BPV), a modifiable risk factor, can compromise cerebral perfusion in critically ill patients. We studied the association between BPV in the intensive care unit (ICU) and short- and long-term cognitive outcomes. ⋯ BPV was associated with increased likelihood of delirium in the ICU. Delirium, but not BPV, was associated with long-term cognitive decline.
-
Background: Conflict between clinicians is prevalent within intensive care units (ICUs) and may hinder optimal delivery of care. However, little is known about the sources of interpersonal conflict and how it manifests within the context of palliative and end-of-life care delivery in ICUs. Objective: To characterize interpersonal conflict in the delivery of palliative care within ICUs. ⋯ In the context of delivering palliative and end-of-life care for critically ill patients, "disagreement" centered around whether patients were appropriate for palliative care, which care plans should be prioritized, and how care should be delivered. "Interference" involved preventing palliative care consultation or goals-of-care discussions and hindering patient care. "Negative emotion" included occurrences of silencing or scolding, rudeness, anger, regret, ethical conflict, and grief. Conclusions: Our findings provide an in-depth understanding of interpersonal conflict within palliative and end-of-life care for critically ill patients. Further study is needed to understand how to prevent and resolve such conflicts.
-
Journal of critical care · Oct 2022
Monitoring and auditing protocol adherence, data integrity and ethical conduct of a randomized clinical trial: A case study.
To categorize, quantify and interpret findings documented in feedback letters of monitoring or auditing visits for an investigator-initiated, peer-review funded multicenter randomized trial testing probiotics for critically ill patients. ⋯ Monitoring and auditing findings predominantly concerned missing documentation with minimal threats to data integrity, patient privacy or safety.
-
Journal of critical care · Oct 2022
The possible predictive value of muscle ultrasound in the diagnosis of ICUAW in long-term critically ill patients.
Intensive Care Unit acquired weakness (ICUAW) occurs commonly. Muscular ultrasonography allows visualization and classification of muscle characteristics. The aims of this study were to evaluate peripheral and respiratory muscles, their changes during long-term ICU stays, and the possible diagnostic predictive value of ICUAW as compared to the Medical Research Council strength score (MRC-SS). ⋯ Quadriceps and respiratory muscles were altered within the first week of mechanical ventilation. The loss of pennation angle offers high diagnostic accuracy for ICUAW, allowing for an earlier diagnosis before patients became able to perform volitional tests.