Critical Care
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2021 ◽  
Vol 35 (6) ◽  
pp. 330-330

2021 ◽  
Vol 35 (6) ◽  
pp. 303-313
Author(s):  
Emily Matone ◽  
Denise Verosky ◽  
Matthew Siedsma ◽  
Erica N. O'Kane ◽  
Dianxu Ren ◽  
...  
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Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1373
Author(s):  
Mousa Ghannam ◽  
Parasteh Malihi ◽  
Krzysztof Laudanski

Electrolyte repletion in the ICU is one of the most ubiquitous tasks in critical care, involving significant resources while having an unclear risk/benefit ratio. Prior data indicate most replacements are administered while electrolytes are within or above reference ranges with little effect on serum post-replacement levels and potential harm. ICU electrolyte replacement patterns were analyzed using the MIMIC-III database to determine the threshold governing replacement decisions and their efficiency. The data of serum values for potassium, magnesium, and phosphate before and after repletion events were evaluated. Thresholds for when repletion was administered and temporal patterns in the repletion behaviors of ICU healthcare providers were identified. Most electrolyte replacements happened when levels were below or within reference ranges. Of the lab orders placed, a minuscule number of them were followed by repletion. Electrolyte repletion resulted in negligible (phosphate), small (potassium), and modest (magnesium) post-replacement changes in electrolyte serum levels. The repletion pattern followed hospital routine work and was anchored around shift changes. A subset of providers conducting over-repletion in the absence of clinical indication was also identified. This pattern of behavior found in this study supports previous studies and may allude to a universal pattern of over-repletion in the ICU setting.


2021 ◽  
Vol 1 (10) ◽  
Author(s):  
Anusree Subramonian ◽  
Jennifer Horton

Three systematic reviews and 2 randomized clinical trials were identified regarding the clinical effectiveness of chlorhexidine oral care in adult patients who were in critical care and being mechanically ventilated. The evidence was of limited quality, with methodological limitations. Compared to ozonated water and to Nanosil, chlorhexidine oral care was associated with a significantly higher risk of ventilator-associated pneumonia. Compared to bicarbonate, chlorhexidine oral care was associated with a significantly lower risk of ventilator-associated pneumonia. There was no significant difference in the risk of ventilator-associated pneumonia between chlorhexidine and other agents, such as potassium permanganate, hydrogen peroxide, or miswak. There was no significant difference in the risk of mortality between oral care with chlorhexidine and that with other oral care drugs. An evidence-based guideline targeting individuals who require assistance on oral care recommended a multi-component oral care protocol. No specific recommendation regarding the use of oral care agents for the prevention of ventilator-associated pneumonia was made because of lack of evidence. There is a lack of evidence on the safety or cost-effectiveness of chlorhexidine oral care in adults who are in critical care and being mechanically ventilated.


2021 ◽  
pp. dtb-2021-000057

AbstractOverview of: Dinh A, Ropers J, Duran C, et al. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial. Lancet 2021;397:1195–203.


2021 ◽  
Author(s):  
Ian Howard ◽  
Rohan Steyn ◽  
Steven George ◽  
Wayne Thomson ◽  
Wael Abdaljawad ◽  
...  

Abstract Introduction The regionalisation of critical care resources has led to an increase in the need to transfer patients between facilities. The advent and implementation of critical care transfer and retrieval services have been the bridge to this divide, lying at the confluence of prehospital emergency care, in-hospital emergency medicine, and intensive care. Within the State of Qatar, the concept of critical care transfer and retrieval is a relatively new. Consequently, we conducted a retrospective cross-sectional study of all transfer and retrieval activity of a dedicated multidisciplinary transfer and retrieval service to better understand the use of these services in the region. Methods Extracted patient care record data were analysed and described using univariate and multivariate descriptive statistics. A log-binomial regression model with robust variance estimator was used to calculate crude and adjusted prevalence ratios for intubation status and arteriovenous access; and intubation status and medication combination, adjusting for age and gender for each model. Results Amongst the completed cases, the majority were male (60.39%), and within the 40-59 (27.7%) age group. Amongst the cases transferred, those with a primary respiratory pathology were the most common (19.59%), followed by cardiovascular patients (18.5%). Half of all patients had a self-maintained airway (51.6%), followed by a third who had an endotracheal tube in situ (36.74%). Midazolam was the most common hypnotic administered (51.27%), as was Fentanyl (88.02%) amongst the analgesic medications, and Noradrenaline amongst the inotropes (72.77%). Intubated patients had the highest proportion of severe and critical patients; patients transported with a Doctor; patients with multiple routes of arterial and/or venous access; and patients receiving any hypnotic, analgesic or inotrope, or a combination thereof. Conclusion The transfer and retrieval of critical care patients across Qatar is a relatively common occurrence. Variations in patient type and severity and the expectations of the transfer team, are significant. Variation in airway type and ventilation modalities, types and combinations of hypnotic, analgesic and inotropes used, and the multitude of arteriovenous access points observed in this study directly contributed towards the complexity of moving these patients from one facility to another.


Neurology ◽  
2021 ◽  
Vol 97 (15) ◽  
pp. 745.2-746
Author(s):  
Nikhil M. Patel ◽  
Quincy K. Tran ◽  
Neeraj Badjatia ◽  
Nicholas A. Morris

Neurology ◽  
2021 ◽  
Vol 97 (15) ◽  
pp. 747.2-748
Author(s):  
Roland Faigle

Neurology ◽  
2021 ◽  
Vol 97 (15) ◽  
pp. 747.1-747
Author(s):  
Noushin Chini Foroush ◽  
Peter Kempster ◽  
Udaya Seneviratne

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