scholarly journals Critical Care EEG Standardized Nomenclature in clinical practice: strengths, limitations, and outlook on the example of prognostication after cardiac arrest

2021 ◽  
Author(s):  
Pia De Stefano ◽  
Margitta Seeck ◽  
Andrea O. Rossetti
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Clinical Practice

scholarly journals Initial Experience of the Levodopa–Entacapone–Carbidopa Intestinal Gel in Clinical Practice

2021 ◽  
Vol 11 (4) ◽  
pp. 254
Author(s):  
Mezin Öthman ◽  
Erik Widman ◽  
Ingela Nygren ◽  
Dag Nyholm
Keyword(s):  
Cardiac Arrest ◽  
Clinical Practice ◽  
Observational Study ◽  
Prospective Studies ◽  
Infusion Rate ◽  
Treatment Duration ◽  
Initial Experience ◽  
Morning Dose ◽  
Efficacy And Safety ◽  
User Friendliness

Patients in fluctuating stages of Parkinson’s disease (PD) require device-aided treatments. Continuous infusion of levodopa–carbidopa intestinal gel (LCIG) is a well-proven option in clinical practice. We now report the first clinical experience of levodopa–entacapone–carbidopa intestinal gel (LECIG) therapy. An observational study of the first patients to start LECIG in our clinic was performed. Twenty-four patients (11 females, 13 males) were included. The median age was 71.5 years, and the median duration since PD diagnosis was 15.5 years. The median treatment duration was 305 days. Median doses were: 6.0 mL as morning dose, 2.5 mL/h as infusion rate, and 1.0 mL as extra dose. Half of the patients were switched directly from LCIG. These patients express improvements in the size and weight of the pump. Furthermore, most of them considered the new pump to be improved regarding user-friendliness. Six patients discontinued LECIG, three due to diarrhea, one due to hallucinations and two deceased (one cardiac arrest and one COVID-19). LECIG has shown to be possible to use in patients with PD, efficacy and safety as expected. Patients are generally happy with the size and usability of the pump, but some technical improvements of the software are warranted, as well as larger, prospective studies.

scholarly journals Minimum standards of clinical practice for physiotherapists working in critical care settings in the United Kingdom: A modified Delphi technique

2018 ◽  
Vol 20 (2) ◽  
pp. 118-131 ◽  
Author(s):  
Paul Twose ◽  
Una Jones ◽  
Gareth Cornell
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
Clinical Practice ◽  
Delphi Technique ◽  
Minimum Standard ◽  
Knowledge And Skills ◽  
Critical Care Units ◽  
Modified Delphi ◽  
The United Kingdom ◽  
Modified Delphi Technique

Introduction Across the United Kingdom, physiotherapy for critical care patients is provided 24 h a day, 7 days per week. There is a national drive to standardise the knowledge and skills of physiotherapists which will support training and reduce variability in clinical practice. Methods A modified Delphi technique using a questionnaire was used. The questionnaire, originally containing 214 items, was completed over three rounds. Items with no consensus were included in later rounds along with any additional items suggested. Results In all, 114 physiotherapists from across the United Kingdom participated in the first round, with 102 and 92 completing rounds 2 and 3, respectively. In total, 224 items were included: 107 were deemed essential as a minimum standard of clinical practice; 83 were not essential and consensus was not reached for 34 items. Analysis/Conclusion This study identified 107 items of knowledge and skills that are essential as a minimum standard for clinical practice by physiotherapists working in United Kingdom critical care units.

scholarly journals Worldwide Clinical Practice of High-Flow Nasal Cannula and Concomitant Aerosol Therapy among Adult Critical Care Subjects

2021 ◽  
pp. respcare.08996
Author(s):  
Jie Li ◽  
Meilien Tu ◽  
Lei Yang ◽  
Guoqiang Jing ◽  
James B Fink ◽  
...  
Keyword(s):  
Critical Care ◽  
Clinical Practice ◽  
High Flow ◽  
Nasal Cannula ◽  
Aerosol Therapy ◽  
High Flow Nasal Cannula

The Contextual Nature of Critical Care Judgment

1994 ◽  
Vol 9 (2) ◽  
pp. 58-63 ◽  
Author(s):  
Gilbert M. Goldman ◽  
Thyyar M. Ravindranath
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Practice ◽  
Clinical Judgment ◽  
Retrospective Review ◽  
Medical Decision Making ◽  
Formal Analysis ◽  
Medical Decision ◽  
Time Constraints ◽  
Care Decision

Critical care decision-making involves principles common to all medical decision-making. However, critical care is a remarkably distinctive form of clinical practice and therefore it may be useful to distinguish those elements particularly important or unique to ICU decision-making. The peculiar contextuality of critical care decision-making may be the best example of these elements. If so, attempts to improve our understanding of ICU decision-making may benefit from a formal analysis of its remarkable contextual nature. Four key elements of the context of critical care decisions can be identified: (1) costs, (2) time constraints, (3) the uncertain status of much clinical data, and (4) the continually changing environment of the ICU setting. These 4 elements comprise the context for the practice of clinical judgment in the ICU. The fact that intensivists are severely constrained by teh context of each case has important ramifications both for practice and for retrospective review. During retrospective review, the contextual nature of ICU judgment may be unfairly neglected by ignoring one or more of the key elements. Such neglect can be avoided if intensivists demand empathetic evaluation from reviewers.

Critical Care of the Post–Cardiac Arrest Patient

2018 ◽  
Vol 36 (3) ◽  
pp. 419-428 ◽  
Author(s):  
Amy C. Walker ◽  
Nicholas J. Johnson
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Cardiac Arrest Patient

Abstract 13686: Variation in Time in Therapeutic Range for Cooling for Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Kevin M Wheelock ◽  
Lian Chen ◽  
Saket Girotra ◽  
Paul S Chan ◽  
Rohan Khera
Keyword(s):  
Cardiac Arrest ◽  
Clinical Practice ◽  
Therapeutic Range ◽  
Interpolation Method ◽  
Controlled Trial ◽  
Linear Interpolation ◽  
Temperature Management ◽  
Level Variation ◽  
Time In Therapeutic Range ◽  
Hospital Cardiac Arrest

Introduction: For comatose survivors of out-of-hospital cardiac arrest (OHCA), targeted temperature management (TTM) is strongly recommended with a goal temperature of 32-36C for a period of at least 24 hours. However, adherence to this target in clinical practice remains unknown. We developed time-in-therapeutic range (TTR) as a treatment metric for patients receiving TTM and evaluated patient- and site-level variation in TTR. Methods: We used data from the Resuscitation Outcomes Consortium-CCC trial which included patients with OHCA across 10 North American sites during 2011-2015. We identified patients who underwent TTM for >12 hours. Serial temperature measures were evaluated between hypothermia start and end times with temperatures between consecutive measures imputed using a linear interpolation method. TTR was defined as percent of time between 32C and 36C during TTM (Fig A). Site was defined based on trial clusters, which represented hospitals served by the same EMS agency. Site-level variation in TTR<90% was evaluated in hierarchical logistic regression using median odds ratio (OR), after adjustment for patient-level factors. Results: A total of 2,695 patients across 49 clusters were included with a median of 45 (IQR: 34 - 52) patients per cluster. The median duration of hypothermia was 23 (IQR: 21 - 24) hours with a median time outside therapeutic range of 0.9 (IQR: 0.0 - 4.2) hours. The median TTR was 96.1% but 1,654 (61%) patients had at least one temperature outside the therapeutic range and 991 (37%) patients had a TTR <90%. There was large variation across sites in the proportion of patients with TTR<90%, ranging from 10% to 68%, with a median OR of 1.74 (Fig B). Conclusions: Within a large randomized controlled trial, more than 1 in 3 OHCA patients treated with TTM had a TTR <90%, with large variation in TTR across sites. These findings highlight an urgent need to focus on improving quality of TTM in clinical practice.

Abstract 48: Neurological Outcomes of Inpatient Cardiopulmonary Resuscitation in a University Hospital

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Lia M Thomas ◽  
Miguel Benavides ◽  
Pierre Kory ◽  
Samuel Acquah ◽  
Steven Bergmann
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Cardiopulmonary Resuscitation ◽  
Therapeutic Hypothermia ◽  
Cardiopulmonary Arrest ◽  
University Hospital ◽  
Neurological Dysfunction ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Neurologically Intact

Background: Despite advances in out- of- hospital resuscitation practices, the prognosis of most patients after a cardiac arrest remains poor. The long term outcomes of patients successfully resuscitated from cardiac arrest are often complicated by neurological dysfunction. Therapeutic hypothermia has significantly improved neurological outcomes in patients successfully resuscitated from out- of- hospital cardiac arrests. The objective of this study was to look into the neurological outcomes in inpatients after successful cardiopulmonary resuscitation (CPR) in a university hospital setting. Methods: This was a retrospective observational study of 68 adult patients who experienced cardiac or respiratory arrest over an 18 month period at a metropolitan teaching hospital with dedicated, trained code teams. Arrests that occurred in the Emergency Department, Critical Care Units or Operating Rooms were excluded. Results: Of the 68 consecutive patients included in this study, 53% were resuscitated successfully. However, only 12 (18%) survived to discharge from the hospital and only 6 (10%) were discharged with intact neurological status. The initial survival was better in patients who received prompt CPR and in those with less co - morbidities. Pulseless electrical activity (PEA) or asystole were the most common rhythms (47% of the arrests). Most patients who survived and were neurologically intact had PEA (67%). We believe that most PEA arrests were more likely severe hypotension with the inability to palpate a pulse rather than true PEA. The mean time to defibrillation for all patients with an initial shockable rhythm (n=5) was 8.2 minutes. Patients who had an initial shockable rhythm and survived to discharge were shocked within 1 minute (n=2). Conclusion: Despite advances in critical care, survival from inpatient cardiopulmonary arrest to neurologically intact discharge remains poor. Therapeutic hypothermia should be expanded to those resuscitated from in - hospital cardiopulmonary arrest to determine if neurological outcomes would improve.

Abstract 301: Identifying Critical Care Unit Organizational Factors That Impact Cardiac Arrest Incidence and Outcomes: A Report From the Pediatric Cardiac Critical Care Consortium

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Javier J Lasa ◽  
Jeffrey A Alten ◽  
Mousumi Banerjee ◽  
Wenying Zhang ◽  
Kurt Schumacher ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Critical Care Unit ◽  
Organizational Factors ◽  
Full Time ◽  
Provider Education ◽  
Multinomial Regression ◽  
Clinical Registry ◽  
The Impact ◽  
Cardiac Critical Care

Introduction: Patient factors leading to cardiac arrest (CA) in the pediatric cardiac critical care unit (CICU) are well understood, but may be unmodifiable. Our understanding of the impact of CICU organizational factors (OFs) such as staffing models, health care provider education, and CICU bed management is limited. The association between these potentially modifiable CICU OFs on CA prevention and rescue outcomes is unknown. Hypothesis: CICU OFs associate with CA prevention and rescue. Methods: Retrospective analysis of Pediatric Cardiac Critical Care Consortium (PC4) clinical registry including data for all patients admitted to CICUs from August 2014 to March 2019. Prevention was defined as the prevalence of subjects not suffering CA. Rescue was defined as survival after CA. CICU OFs were captured via questionnaire distributed to PC4 participants in 2017 (100% response). Stratified, multivariable regression was used to evaluate associations between OFs and outcome in medical and surgical admission subgroups: competing time-to-events framework (to assess prevention) and multinomial regression (to assess rescue), accounting for clustering of patients within hospitals. Results: We analyzed 54,521 CICU admissions (59% surgical, 41% medical) from 29 hospitals with 1398 CA events (2.5%). We studied 12 OFs that varied across centers after accounting for collinearity. For both surgical and medical admissions, lower average daily occupancy (<80%) was associated with better arrest prevention for all admissions, and better rescue in the surgical cohort. Increased proportion of nurses with >2 years experience, increased proportion of nurses with critical care certification, % of full-time intensivists, % of intensivists with critical care training, dedicated respiratory therapists, quality/safety resources, and annual CICU admission volume were not associated with improved prevention or rescue. Conclusion: Our multi-institutional analysis suggests that lower average CICU occupancy was the only consistent OF evaluated that was associated with CA prevention and rescue. CICUs that have average daily occupancy >80% may need specific strategies to mitigate the risks of CA.

Critical Care Research: Weaving a Body-Mind-Spirit Tapestry

2004 ◽  
Vol 13 (4) ◽  
pp. 320-327 ◽  
Author(s):  
Cathie E. Guzzetta
Keyword(s):  
Critical Care ◽  
Clinical Practice ◽  
Care Research ◽  
Research Studies

Master weavers historically characterize the weaving of a tapestry as a calling, a transformation, a healing or sacred work. Tapestries are created by the collective efforts of many and are configured by the weavers’ consciousness and spirit. A holistic framework used to weave a body-mind-spirit tapestry for guiding holistic clinical practice and research is described. Various research studies that document the effects of holistic interventions on patients’ outcomes are examined. Implications for clinical practice are explored.

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