Articles: critical-illness.
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Since the 1990s, time-limited trials have been described as an approach to navigate uncertain benefits and limits of life-sustaining therapies in patients with critical illness. In this review, we aim to synthesize the evidence on time-limited trials in critical care, establish what is known, and highlight important knowledge gaps. ⋯ Time-limited trials are endorsed by physicians, align with the priorities of some older adults, and are part of current practice. Substantial efforts are needed to test their impact on patient-centered outcomes, improve their implementation, and maximize their potential benefit.
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J Clin Monit Comput · Apr 2024
Early prediction of mortality at sepsis diagnosis time in critically ill patients by using interpretable machine learning.
This study applied machine learning for the early prediction of 30-day mortality at sepsis diagnosis time in critically ill patients. Retrospective study using data collected from the Medical Information Mart for Intensive Care IV database. The data of the patient cohort was divided on the basis of the year of hospitalization, into training (2008-2013), validation (2014-2016), and testing (2017-2019) datasets. 24,377 patients with the sepsis diagnosis time < 24 h after intensive care unit (ICU) admission were included. ⋯ The calibration plot for the model revealed a slope of 1.03 (95% CI 0.94-1.12) and intercept of 0.14 (95% CI 0.04-0.25). The SHAP revealed the top three most significant features, namely age, increased red blood cell distribution width, and respiratory rate. Our study demonstrated the feasibility of using the interpretable machine learning model to predict mortality at sepsis diagnosis time.
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Recent large-scale randomized controlled trials (RCTs) challenged current beliefs about the potential role of micronutrients to attenuate the inflammatory response and improve clinical outcomes of critically ill patients. The purpose of this narrative review is to provide an overview and critical discussion about most recent clinical trials, which evaluated the clinical significance of a vitamin C, vitamin D, or selenium administration in critically ill patients. ⋯ Current data received from most recent large-scale RCTs could not demonstrate clinically meaningful effects of an intervention with either vitamin C, vitamin D, or selenium in critically ill patients. More attention is needed to carefully identify potential confounding factors and to better evaluate the role of timing, duration, and combined strategies.
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Revista médica de Chile · Apr 2024
Review[Decision-Making by Hospital Teams Regarding Access and Use of Life-Support Technology and End-of-Life Processes in Critically Ill Adult Patients: A Narrative Review].
Death processes have been progressively transferred to hospital spaces due to biomedicalization and the use of technologies, generating important challenges for healthcare systems. The COVID-19 pandemic exposed the lack of unified criteria and principles for a dignified death in the hospital. This study corresponds to a narrative review using Higgins & Green's methodological framework as a reference. ⋯ The evidence shows variability in decision-making associated with the clinical status of the patient, the criteria of the medical professional, added to structural elements of the health system and political-legal aspects. The literature recommends reflexive, dynamic, flexible, and individualized decision-making processes that consider the patient's preferences, clinical judgment, prognosis, and available resources. Communication, advance care planning, interdisciplinary discussions, external consultations, and the involvement of ethical committees are crucial throughout the process.