Are two (inexperienced) heads better than one (experienced) head? Averaging house officers' prognostic judgments for critically ill patients

Background. Conditions of reduced perfusion are characterized by redistribution of blood flow away from the skin to more vital organs. Objectives. To assess the efficacy of a noninvasive, dermal blood flow (DBF) monitor in detecting changes in perfusion in critically ill patients. Methods. Eleven adult, critically ill patients in a general ICU were studied. DBF, finger plethysmography, and invasive mean arterial pressure (MAP) were recorded over an 8-hour period. DBF was measured using the DermaFlow DBF monitor via a skin probe placed on the anterior chest wall. Sensitivity was evaluated by visual inspection during active states, either induced, for example, fluid administration, or spontaneous, for example, altered hemodynamics, while specificity was evaluated during stable states. Data are expressed in terms of standard deviation of the difference (SDD) between the MAP and each of the tested methods. Results. The DBF detected all true changes detected by MAP while plethysmography detected fewer of these events. Based on SDD, the specificity of the DBF was found to be better than that of plethysmography and close in value to the MAP. Conclusions. This preliminary study suggests that the DBF monitor may be a useful noninvasive method for detecting changes in perfusion in critically ill patients.

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Faculty Opinions recommendation of Four hour creatinine clearance is better than plasma creatinine for monitoring renal function in critically ill patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717950098.793455361 ◽

2012 ◽

Author(s):

Sean Bagshaw

Keyword(s):

Renal Function ◽

Creatinine Clearance ◽

Critically Ill ◽

Critically Ill Patients ◽

Plasma Creatinine ◽

Better Than

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Can Intermittent Pneumatic Compression Reduce the Incidence of Venous Thrombosis in Critically Ill Patients: A Systematic Review and Meta-Analysis

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620913942 ◽

2020 ◽

Vol 26 ◽

pp. 107602962091394

Author(s):

Yiwei Wang ◽

Dong Huang ◽

Maoyun Wang ◽

Zongan Liang

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Intermittent Pneumatic Compression ◽

Adjunctive Treatment ◽

Compression Stockings ◽

Bleeding Events ◽

Randomized Controlled ◽

P 16 ◽

Better Than

Venous thromboembolism (VTE) is a common complication for critically ill patients. Intermittent pneumatic compression (IPC) is recommended for patients with high risk of bleeding. We aim to evaluate the effectiveness of IPC for thromboprophylaxis in critically ill patients. We searched PubMed, Embase, and ClinicalTrials for randomized controlled trials (RCTs) and observational studies that evaluated IPC in critically ill patients. RevMan 5.3 software was used for the meta-analysis. A total of 10 studies were included. The IPC group significantly reduced the VTE incidence compared with no thromboprophylaxis group (risk ratio [RR]: 0.35, confidence interval [CI]: 0.18-0.68, P = .002) and the IPC group also showed lower VTE incidence than the graduated compression stockings (GCS) group (RR: 0.47, CI: 0.24-0.91, P = .03). There were no significant differences between using IPC and low-molecular-weight heparin (LMWH) for VTE incidence (RR: 1.26, CI: 0.72-2.22, P = .41), but LMWH showed significantly more bleeding events. Intermittent pneumatic compression as an adjunctive treatment did not further reduce VTE incidence (RR: 0.55, CI: 0.24-1.27, P = .16). Intermittent pneumatic compression can reduce the incidence of VTE for critically ill patients, which is better than GCS and similar to LMWH, but it has no significant advantage as an adjunct therapy for thromboprophylaxis.

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