Tag: strategy
Time to Add a Fifth Pillar to Bedside Physical Examination
Inspection, palpation, percussion, and auscultation have been the 4 pillars of clinical bedside medicine. Although these basic methods of physical examination have served us well, traditional bedside examination, for a number... read more
Sleep Deprived-Patients in ICU May Fail to Get Off Ventilation
Attempts to wean intubated, critically ill patients off mechanical ventilators were less successful when the patients exhibited atypical sleep or pathological wakefulness, researchers reported. The findings suggest that sleep... read more
Effect of Titrating PEEP with Esophageal Pressure-Guided Strategy vs Empirical High PEEP-Fio2 Strategy on Death and Days Free From Mechanical Ventilation Among Patients With ARDS
Among patients with moderate to severe Acute Respiratory Distress Syndrome (ARDS), PES-guided positive end-expiratory pressure (PEEP), compared with empirical high PEEP-Fio2, resulted in no significant difference in death... read more
The Artificial Intelligence Clinician Learns Optimal Treatment Strategies for Sepsis in Intensive Care
Sepsis is the third leading cause of death worldwide and the main cause of mortality in hospitals but the best treatment strategy remains uncertain. In particular, evidence suggests that current practices in the administration... read more
Fluid Management in Acute Respiratory Distress Syndrome
In this video, Dr. Stacey Valentine discusses fluid management in acute respiratory distress syndrome (ARDS), including the evidence supporting fluid-restrictive strategies. Both acute lung injury and its more severe form,... read more
Metabolic Sepsis Resuscitation
There are roughly two strategies for adjusting the intensity of treatment: Titrated strategy: Treatment intensity is adjusted to match the severity of the disease. Escalation-deescalation strategy: Treatment intensity is... read more
EHR-guided Strategy Reduces Postop VTE Events
By incorporating algorithms into the electronic health record (EHR), UPMC was able to realize a "dramatic" 72% reduction in missed doses, from 4,331 missed doses in 2014 to 1,193 in 2015, Dr. Neal told attendees in a session... read more
We Should Avoid the Term “Fluid Overload”
Using the right word or phrase to describe a specific pathologic process/patient diagnosis and/or status is important, not only within the intensive care unit team, but also when we communicate with external consultants.... read more
SOS Asynchronies: Do We Need Help?
Synchrony between the patient and the ventilator is defined as the appropriate interaction between the two, where the ventilator recognizes patient’s effort and provides support for breathing at the right time—that is,... read more
Out-of-hours Discharge from ICU, In-hospital Mortality and ICU Readmission Rates
Out-of-hours discharge from an ICU is strongly associated with both in-hospital death and ICU readmission. These effects persisted across all definitions of “out of hours” and across healthcare systems in different geographical... read more
Ranking antibiotics in order of allergenicity
Our current approach to allergy is primarily patient-based. This focuses on the patient’s prior history of reaction: how severe was it, when was it, how certain are we that it was truly allergic? This strategy has been... read more
Timing of Renal Support and Outcome of Septic Shock and ARDS
Early RRT initiation strategy was not associated with any improvement of 60-day mortality in patients with severe acute kidney injury and septic shock or Acute Respiratory Distress Syndrome (ARDS). Unnecessary and potentially... read more
Pediatric Sepsis Endotypes Among Adults With Sepsis
Recent transcriptomic studies describe two subgroups of adults with sepsis differentiated by a sepsis response signature. The implied biology and related clinical associations are comparable with recently reported pediatric... read more
Effect of a Multifaceted Performance Feedback Strategy on Length of Stay Compared With Benchmark Reports Alone
In the context of ICUs participating in a national registry, applying a multifaceted activating performance feedback strategy did not lead to better patient outcomes than only receiving periodical registry reports. The extent... read more
More Than a Tick Box: Medical Checklist Development, Design, and Use
Despite improving patient safety in some perioperative settings, some checklists are not living up to their potential and complaints of "checklist fatigue" and outright rejection of checklists are growing. Problems reported... read more
Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery
The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable... read more
Early goal-directed nutrition in ICU patients (EAT-ICU)
Extensive weight loss has been documented in intensive care unit (ICU) survivors, primarily as the result of muscle loss, leading to impaired physical function and reduced quality of life. The aim of the EAT-ICU trial is... read more
