Tag: guidelines

Upvote Story 4
Guideline adherence to an expert panel predefined care set in brain death (DBD) donor management proved moderate leaving substantial room for improvement. An importance-performance analysis can be used to improve implementation and documentation of guidelines. A total of 296 patients were included. Thirty-five of 67 KIs had a high level of adherence congruent to a high expert panel rating of importance. Nineteen of 67 KIs... Read More | Comment
Upvote Story 26
This recently released practically oriented book provides an up-to-date overview of all significant aspects of the pathogenesis of sepsis and its management, including within the ICU. Readers will find information on the involvement of the coagulation and endocrine systems during sepsis and on the use of biomarkers to diagnose sepsis and allow early intervention. International clinical practice guidelines for the management of sepsis are presented,... Read More | Comment
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Recent studies suggest that hypotension thresholds in current guidelines might be too low for older patients due to arterial stiffening, possibly leading to insufficient fluid resuscitation. We compared intravenous (IV) fluid volumes that older (≥ 70 years) and younger ( Read More | Comment
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With a focus on evidence-based, state-of-the-art information throughout, the eighth edition of Irwin and Rippe’s Intensive Care Medicine offers authoritative guidance to the wide variety of specialty physicians and non-physicians practicing in the adult intensive care environment. This comprehensive textbook covers both the theoretical and practical aspects of the field, and has been completely updated to provide encyclopedic, interprofessional coverage to support practitioners in every... Read More | Comment
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Delirium is defined as an acute disorder of consciousness which can occur in up to 80% of mechanically ventilated ICU patients. This acute cognitive dysfunction is associated with prolonged hospital stay, increased mortality, longer periods of mechanical ventilation and long-term cognitive impairment compared to patients without delirium. Haloperidol, remains one of the most commonly used typical antipsychotics used to treat delirium internationally and within the... Read More | Comment
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Angiotensin II has been studied for many years and has consistently shown to increase MAP. This medication adds a new mechanism of action to the vasopressor arsenal that is already used for septic shock. Angiotensin II should be reserved for patients in septic shock who do not respond to high doses of catecholamines and vasopressin. The only drug interactions with angiotensin II known to date... Read More | Comment
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This JAMA Clinical Guidelines Synopsis summarizes the American College of Chest Physicians' 2016 recommendations on antithrombotic therapy for venous thromboembolism (VTE). The estimated annual incidence of VTE, defined as DVT of the leg or PE, ranges from 104 to 183 per 100 000 person-years. Compared with those without VTE, the 30-year mortality risk is increased for survivors of an episode of VTE and for survivors of... Read More | Comment
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The evidence-based ABCDEF bundle was successfully implemented in seven community hospital ICUs using an interprofessional team model to operationalize the Pain, Agitation, and Delirium guidelines. Higher bundle compliance was independently associated with improved survival and more days free of delirium and coma after adjusting for age, severity of illness, and presence of mechanical ventilation. Total and partial bundle compliance were measured daily. Random effects regression... Read More | Comment
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It is a longstanding cultural norm to provide supplemental oxygen to sick patients regardless of their blood oxygen saturation. A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in hospital. Patients randomised to liberal oxygen therapy were more likely to die (risk ratio 1.21 (95% confidence interval 1.03 to 1.43)). The increase in mortality was highest... Read More | Comment
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The current conflicts of interest (COIs) disclosure forms of selected professional societies provide more attention to financial disclosures and COIs and less attention to detecting and managing intellectual COIs, while rarely addressing institutional COIs. We provide some suggestions for guideline developers on the classification and management of different COIs in the context of CPGs. All selected professional critical care societies require that members declare direct... Read More | Comment
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This book establishes the indications for the use of NIV in the context of weaning from invasive mechanical ventilation. It provides a comprehensive overview of key topics relevant for correct practical application, including NIV and weaning principles, important aspects of patient care before and after weaning, and pediatric and neonatology weaning. Finally, the book summarizes international guidelines and new perspectives of NIV during weaning. With... Read More | Comment
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Following the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to... Read More | Comment
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Acute kidney injury (AKI) in the perioperative period is a common complication and is associated with increased morbidity and mortality. A standard definition and staging system for AKI has been developed, incorporating a reduction of the urine output and/or an increase of serum creatinine. Novel biomarkers may detect kidney damage in the absence of a change in function and can also predict the development of... Read More | Comment
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Sepsis is medicine’s last remaining preserve for unrestrained antibiotic prescribing. The Surviving Sepsis Campaign guidelines recommend empirical broad-spectrum therapy within one hour of triage for both sepsis and septic shock. This recommendation, and mandates that compel it, encourage clinicians to adopt an approach of “treat first, ask questions later” for patients with any possibility of serious infection. This approach fails to account for the difficulties... Read More | Comment
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Writing in the MJA, researchers have reported the findings of a prospective cohort study comparing estimates of the incidence and mortality of sepsis using clinical diagnosis or the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS CORE) database methodology. The researchers found that when compared with clinical diagnosis, the ANZICS CORE database criteria significantly underestimated the incidence of sepsis... Read More | Comment