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[PMID]:28453823
[Au] Autor:Borgert M; Binnekade J; Paulus F; Goossens A; Dongelmans D
[Ad] Endereço:Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
[Ti] Título:A flowchart for building evidence-based care bundles in intensive care: based on a systematic review.
[So] Source:Int J Qual Health Care;29(2):163-175, 2017 Apr 01.
[Is] ISSN:1464-3677
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Purpose: The Institute for Healthcare Improvement is the founder of the care bundled approach and described the methods used on how to develop care bundles. However, other useful methods are published as well. In this systematic review, we identified what different methods were used to design care bundles in intensive care units. The results were used to build a comprehensive flowchart to guide through the care bundle design process. Data sources: Electronic databases were searched for eligible studies in PubMed, EMBASE and CINAHL from January 2001 to August 2014. Study selection: There were no restrictions on the types of study design eligible for inclusion. Methodological quality was assessed by using the Downs & Black-checklist or Appraisal of Guidelines, REsearch and Evaluation II. Data extraction: Data extraction was independently performed by two reviewers. Results of data synthesis: A total of 4665 records were screened and 18 studies were finally included. The complete process of designing bundles was reported in 33% (6/18). In 50% (9/18), one of the process steps was described. A narrative report was written about care bundles in general in 17% (3/18). We built a comprehensive flowchart to visualize and structure the process of designing care bundles. Conclusion: We identified useful methods for designing evidence-based care bundles. We built a comprehensive flowchart to provide an overview of the methods used to design care bundles so that others could choose their own applicable method. It guides through all necessary steps in the process of designing care bundles.
[Mh] Termos MeSH primário: Unidades de Terapia Intensiva/organização & administração
Pacotes de Assistência ao Paciente/métodos
[Mh] Termos MeSH secundário: Prática Clínica Baseada em Evidências/métodos
Seres Humanos
Melhoria de Qualidade/organização & administração
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/intqhc/mzx009


  2 / 44512 MEDLINE  
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[PMID]:29444391
[Au] Autor:Loo MV; Sottiaux T
[Ti] Título:High Flow Nasal Cannula oxygenation for adult patients in the ICU: a literature review.
[So] Source:Acta Anaesthesiol Belg;67(2):63-72, 2016.
[Is] ISSN:0001-5164
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:Oxygenation using High Flow Nasal Cannula (HFNC) was initially described in neonatal medicine, but, gradually, its use has extended to adult patients. The efficacy of the device has been linked to higher flows of oxygen delivered to the patients, air tract humidification, alveolar recruitment through a positive end-expiratory pressure (PEEP) effect, prevention of nasopharyngeal collapse, and dead-space washout. Beside the fact that HFNC is a non-invasive way of delivering oxygen to ICU patients, and is well tolerated, results from various clinical trials tend to show positive outcomes for patients presenting with acute hypoxemic respiratory failure (AHRF), during intubation, or during the post-extubation period. However, controversy arose from recent publications, and larger trials are still required to clarify the position of HFNC in the ICU, and help define the subgroups of patients presenting with AHRF that are most likely to benefit from HFNC therapy.
[Mh] Termos MeSH primário: Cânula
Unidades de Terapia Intensiva
Oxigenoterapia/instrumentação
[Mh] Termos MeSH secundário: Adulto
Extubação
Seres Humanos
Oxigenoterapia/efeitos adversos
Oxigenoterapia/métodos
Respiração com Pressão Positiva
Insuficiência Respiratória/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE


  3 / 44512 MEDLINE  
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[PMID]:27770828
[Au] Autor:Álvarez-Lerma F; Marín-Corral J; Vila C; Masclans JR; González de Molina FJ; Martín Loeches I; Barbadillo S; Rodríguez A; H1N1 GETGAG/SEMICYUC Study Group
[Ad] Endereço:Service of Intensive Care Medicine, Hospital del Mar, Passeig Marítim 25-29, E-08003, Barcelona, Spain. FAlvarez@parcdesalutmar.cat.
[Ti] Título:Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome.
[So] Source:Crit Care;20(1):337, 2016 Oct 23.
[Is] ISSN:1466-609X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU. METHODS: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis. RESULTS: In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001). CONCLUSIONS: Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.
[Mh] Termos MeSH primário: Influenza Humana/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Idoso
Distribuição de Qui-Quadrado
Estado Terminal/epidemiologia
Diagnóstico Tardio
Feminino
Mortalidade Hospitalar
Seres Humanos
Vírus da Influenza A Subtipo H1N1/patogenicidade
Unidades de Terapia Intensiva/organização & administração
Unidades de Terapia Intensiva/estatística & dados numéricos
Tempo de Internação
Modelos Logísticos
Masculino
Meia-Idade
Razão de Chances
Estudos Prospectivos
Fatores de Risco
Espanha/epidemiologia
Estatísticas não Paramétricas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


  4 / 44512 MEDLINE  
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[PMID]:29274212
[Au] Autor:Modrzewska BD; Kurnatowska, AJ; Khalid K
[Ad] Endereço:Department of Biology and Medical Parasitology, Medical University of Lodz, Hallera Sq. 1, 90-647 Lodz, Poland
[Ti] Título:Drug susceptibility of fungi isolated from ICU patients
[So] Source:Ann Parasitol;63(3):189-198, 2017.
[Is] ISSN:2299-0631
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:Candida species can be a reason of infections associated with high morbidity and mortality. The risk of invasive candidosis for patients admitted to intensive care units (ICUs) is increased due to immunosuppressive states, prolonged length of stay, broad-spectrum antibiotics and Candida colonization. The aim of the study was to determine selected properties of fungi isolated from patients treated in the ICUs of hospitals in Lodz. The materials were collected from the oral cavity, the tracheostomy or endotracheal tube and urine from 16 children and 35 adult. In total, 127 samples were examined to differentiate the fungal strains with used morphological and biochemical methods. Candida species were isolated from adult patients (82.9%), but were not isolated from any of the children; C. albicans was the predominant fungus (61.7%), much less frequent were C. glabrata (12.8%), C. tropicalis (6.4%) and C. kefyr, C. dubliniensis (4.3% each).The susceptibility of fungi to antimycotic drugs revealed that almost all of the strains were susceptible to nystatin (97.9%) and to amphotericin B (72.3%), and resistant to fluconazole (72.3%) and ketoconazole (57.5%). No isolation of fungi from children remaining in ICU may be an evidence of high sanitary regime at these wards; fungi from the genus Candida are the etiological factors for ICU infections; 3/5 of them are caused by C. albicans, mostly of the code 2 576 174, characteristic for strains isolated from hospitalized patients; it is necessary to determine the species of the fungus and its susceptibility to drugs, which allows to conduct effective therapy; prophylactic administration of fluconazole leads to an increase in the number of strains resistant to this chemotherapeutic agent; in the antifungal local treatment, nystatin should be a drug of choice as the drug to which most fungi are susceptible.
[Mh] Termos MeSH primário: Antifúngicos/farmacologia
Candida/efeitos dos fármacos
Candidíase/microbiologia
Farmacorresistência Fúngica
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Antifúngicos/uso terapêutico
Criança
Pré-Escolar
Infecção Hospitalar/microbiologia
Feminino
Seres Humanos
Lactente
Recém-Nascido
Unidades de Terapia Intensiva
Masculino
Meia-Idade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antifungal Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171224
[St] Status:MEDLINE
[do] DOI:10.17420/ap6303.105


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[PMID]:28460438
[Au] Autor:Chen X; Zhu W; Tan J; Nie H; Liu L; Yan D; Zhou X; Sun X
[Ad] Endereço:Chinese Cochrane Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, Sichuang, China.
[Ti] Título:Early outcome of early-goal directed therapy for patients with sepsis or septic shock: a systematic review and meta-analysis of randomized controlled trials.
[So] Source:Oncotarget;8(16):27510-27519, 2017 Apr 18.
[Is] ISSN:1949-2553
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Various trials and meta-analyses have reported conflicting results concerning the application of early goal-directed therapy (EGDT) for sepsis and septic shock. The aim of this study was to update the evidence by performing a systematic review and meta-analysis. Multiple databases were searched from initial through August, 2016 for randomized controlled trials (RCTs) which investigated the associations between the use of EGDT and mortality in patients with sepsis or septic shock. Meta-analysis was performed using random-effects model and heterogeneity was examined through subgroup analyses. The primary outcome of interest was patient all-cause mortality including hospital or ICU mortality. Seventeen RCTs including 6207 participants with 3234 in the EGDT group and 2973 in the control group were eligible for this study. Meta-analysis showed that EGDT did not significantly reduce hospital or intensive care unit (ICU) mortality (relative risk [RR] 0.89, 95% CI 0.78 to 1.02) compared with control group for patients with sepsis or septic shock. The findings of subgroup analyses stratified by study region, number of research center, year of enrollment, clinical setting, sample size, timing of EGDT almost remained constant with that of the primary analysis. Our findings provide evidence that EGDT offers neutral survival effects for patients with sepsis or septic shock. Further meta-analyses based on larger well-designed RCTs or individual patient data meta-analysis are required to explore the survival benefits of EDGT in patients with sepsis or septic shock.
[Mh] Termos MeSH primário: Sepse/terapia
Choque Séptico/terapia
Tempo para o Tratamento
[Mh] Termos MeSH secundário: Terapia Combinada
Gerenciamento Clínico
Mortalidade Hospitalar
Seres Humanos
Unidades de Terapia Intensiva
Razão de Chances
Viés de Publicação
Ensaios Clínicos Controlados Aleatórios como Assunto
Sepse/diagnóstico
Sepse/mortalidade
Choque Séptico/diagnóstico
Choque Séptico/mortalidade
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.18632/oncotarget.15550


  6 / 44512 MEDLINE  
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[PMID]:28459497
[Au] Autor:Smith JM; Van Aman MN; Schneiderhahn ME; Edelman R; Ercole PM
[Ti] Título:Assessment of Delirium in Intensive Care Unit Patients: Educational Strategies.
[So] Source:J Contin Educ Nurs;48(5):239-244, 2017 May 01.
[Is] ISSN:1938-2472
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Delirium is an acute brain dysfunction associated with poor outcomes in intensive care unit (ICU) patients. Critical care nurses play an important role in the prevention, detection, and management of delirium, but they must be able to accurately assess for it. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) instrument is a reliable and valid method to assess for delirium, but research reveals most nurses need practice to use it proficiently. METHOD: A pretest-posttest design was used to evaluate the success of a multimodal educational strategy (i.e., online learning module coupled with standardized patient simulation experience) on critical care nurses' knowledge and confidence to assess and manage delirium using the CAM-ICU. RESULTS: Participants (N = 34) showed a significant increase (p < .001) in confidence in their ability to assess and manage delirium following the multimodal education. No statistical change in knowledge of delirium existed following the education. CONCLUSION: A multimodal educational strategy, which included simulation, significantly added confidence in critical care nurses' performance using the CAM-ICU. J Contin Nurs Educ. 2017;48(5):239-244.
[Mh] Termos MeSH primário: Competência Clínica
Enfermagem de Cuidados Críticos/educação
Delírio/diagnóstico
Delírio/enfermagem
Educação Continuada em Enfermagem/organização & administração
Avaliação Educacional/métodos
Recursos Humanos de Enfermagem no Hospital/educação
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Cuidados Críticos/métodos
Feminino
Seres Humanos
Unidades de Terapia Intensiva/organização & administração
Masculino
Meia-Idade
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.3928/00220124-20170418-09


  7 / 44512 MEDLINE  
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[PMID]:28458027
[Au] Autor:Herta J; Koren J; Fürbass F; Zöchmeister A; Hartmann M; Hosmann A; Baumgartner C; Gruber A
[Ad] Endereço:Department of Neurosurgery, Medical University of Vienna, Vienna, Austria. Electronic address: johannes.herta@meduniwien.ac.at.
[Ti] Título:Applicability of NeuroTrend as a bedside monitor in the neuro ICU.
[So] Source:Clin Neurophysiol;128(6):1000-1007, 2017 06.
[Is] ISSN:1872-8952
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess whether ICU caregivers can correctly read and interpret continuous EEG (cEEG) data displayed with the computer algorithm NeuroTrend (NT) with the main attention on seizure detection and determination of sedation depth. METHODS: 120 screenshots of NT (480h of cEEG) were rated by 18 briefly trained nurses and biomedical analysts. Multirater agreements (MRA) as well as interrater agreements (IRA) compared to an expert opinion (EXO) were calculated for items such as pattern type, pattern location, interruption of recording, seizure suspicion, consistency of frequency, seizure tendency and level of sedation. RESULTS: MRA as well as IRA were almost perfect (80-100%) for interruption of recording, spike-and-waves, rhythmic delta activity and burst suppression. A substantial agreement (60-80%) was found for electrographic seizure patterns, periodic discharges and seizure suspicion. Except for pattern localization (70.83-92.26%), items requiring a precondition and especially those who needed interpretation like consistency of frequency (47.47-79.15%) or level of sedation (41.10%) showed lower agreements. CONCLUSIONS: The present study demonstrates that NT might be a useful bedside monitor in cases of subclinical seizures. Determination of correct sedation depth by ICU caregivers requires a more detailed training. SIGNIFICANCE: Computer algorithms may reduce the workload of cEEG analysis in ICU patients.
[Mh] Termos MeSH primário: Cuidados Críticos/métodos
Eletroencefalografia/instrumentação
Monitorização Neurofisiológica/instrumentação
Sistemas Automatizados de Assistência Junto ao Leito
Convulsões/diagnóstico
Software
[Mh] Termos MeSH secundário: Adulto
Atitude do Pessoal de Saúde
Eletroencefalografia/métodos
Seres Humanos
Unidades de Terapia Intensiva
Meia-Idade
Monitorização Neurofisiológica/métodos
Enfermeiras Especialistas/psicologia
Enfermeiras Especialistas/normas
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


  8 / 44512 MEDLINE  
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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
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[PMID]:29466591
[Au] Autor:van den Boogaard M; Slooter AJC; Brüggemann RJM; Schoonhoven L; Beishuizen A; Vermeijden JW; Pretorius D; de Koning J; Simons KS; Dennesen PJW; Van der Voort PHJ; Houterman S; van der Hoeven JG; Pickkers P; REDUCE Study Investigators
[Ad] Endereço:Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
[Ti] Título:Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial.
[So] Source:JAMA;319(7):680-690, 2018 02 20.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Results of studies on use of prophylactic haloperidol in critically ill adults are inconclusive, especially in patients at high risk of delirium. Objective: To determine whether prophylactic use of haloperidol improves survival among critically ill adults at high risk of delirium, which was defined as an anticipated intensive care unit (ICU) stay of at least 2 days. Design, Setting, and Participants: Randomized, double-blind, placebo-controlled investigator-driven study involving 1789 critically ill adults treated at 21 ICUs, at which nonpharmacological interventions for delirium prevention are routinely used in the Netherlands. Patients without delirium whose expected ICU stay was at least a day were included. Recruitment was from July 2013 to December 2016 and follow-up was conducted at 90 days with the final follow-up on March 1, 2017. Interventions: Patients received prophylactic treatment 3 times daily intravenously either 1 mg (n = 350) or 2 mg (n = 732) of haloperidol or placebo (n = 707), consisting of 0.9% sodium chloride. Main Outcome and Measures: The primary outcome was the number of days that patients survived in 28 days. There were 15 secondary outcomes, including delirium incidence, 28-day delirium-free and coma-free days, duration of mechanical ventilation, and ICU and hospital length of stay. Results: All 1789 randomized patients (mean, age 66.6 years [SD, 12.6]; 1099 men [61.4%]) completed the study. The 1-mg haloperidol group was prematurely stopped because of futility. There was no difference in the median days patients survived in 28 days, 28 days in the 2-mg haloperidol group vs 28 days in the placebo group, for a difference of 0 days (95% CI, 0-0; P = .93) and a hazard ratio of 1.003 (95% CI, 0.78-1.30, P=.82). All of the 15 secondary outcomes were not statistically different. These included delirium incidence (mean difference, 1.5%, 95% CI, -3.6% to 6.7%), delirium-free and coma-free days (mean difference, 0 days, 95% CI, 0-0 days), and duration of mechanical ventilation, ICU, and hospital length of stay (mean difference, 0 days, 95% CI, 0-0 days for all 3 measures). The number of reported adverse effects did not differ between groups (2 [0.3%] for the 2-mg haloperidol group vs 1 [0.1%] for the placebo group). Conclusions and Relevance: Among critically ill adults at high risk of delirium, the use of prophylactic haloperidol compared with placebo did not improve survival at 28 days. These findings do not support the use of prophylactic haloperidol for reducing mortality in critically ill adults. Trial Registration: clinicaltrials.gov Identifier: NCT01785290.
[Mh] Termos MeSH primário: Antipsicóticos/administração & dosagem
Estado Terminal/mortalidade
Delírio/prevenção & controle
Haloperidol/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Antipsicóticos/efeitos adversos
Relação Dose-Resposta a Droga
Método Duplo-Cego
Feminino
Haloperidol/efeitos adversos
Seres Humanos
Unidades de Terapia Intensiva
Masculino
Meia-Idade
Modelos de Riscos Proporcionais
Fatores de Risco
Análise de Sobrevida
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antipsychotic Agents); J6292F8L3D (Haloperidol)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2018.0160


  9 / 44512 MEDLINE  
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[PMID]:29428034
[Au] Autor:Duchesne J; Majoue C; Duke M; Robledo R; Achord C; McHale L; Davis B; Nahapetyan L
[Ti] Título:Impact of Trauma-Certified Registered Nurse Anesthetists Team on Intra-Operative Resuscitation and Postoperative Outcomes of Trauma Patients.
[So] Source:Am Surg;84(1):93-98, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A Trauma Certified Registered Nurse Anesthetists Team (TCT) was created and trained to provide trauma-focused anesthesia and resuscitation. The purpose of this study was to examine patient outcomes after implementation of TCT. We conducted retrospective analyses of trauma patients managed with surgical intervention from March to December 2015. During the first five months, patients managed before the development of TCT were grouped No-TCT, patients managed after were grouped TCT. To assess outcomes, we used hospital and intensive care unit length of stay, ventilator days, and a validated 10-point intraoperative Apgar score (IOAS). IOAS is calculated using the estimated blood loss, lowest heart rate, and lowest mean arterial pressure during surgery. Higher IOAS are associated with significantly decreased complications and mortality after surgery. We used t test and nonparametric tests for analyses. Fifty two patients were included (mean age 39 years, 75% male; 46.2% managed with TCT). Patients in the No-TCT group had significantly lower use of vasopressors (0.019), lower mean IOAS (P = 0.02), and spent more days on ventilator (P = 0.005) than patients in the TCT. These results suggest that trauma centers should take into consideration implementation of TCT to improve intraoperative and overall outcomes.
[Mh] Termos MeSH primário: Cuidados Intraoperatórios/enfermagem
Enfermeiras Anestesistas
Enfermeiras e Enfermeiros
Cuidados Pós-Operatórios/enfermagem
Ressuscitação/enfermagem
Centros de Traumatologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Unidades de Terapia Intensiva
Cuidados Intraoperatórios/mortalidade
Masculino
Meia-Idade
Cuidados Pós-Operatórios/mortalidade
Reprodutibilidade dos Testes
Ressuscitação/mortalidade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


  10 / 44512 MEDLINE  
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[PMID]:29406045
[Au] Autor:Jalil B; Thompson P; Cavallazzi R; Marik P; Mann J; El-Kersh K; Guardiola J; Saad M
[Ad] Endereço:Division of Pulmonary, Department of Medicine, Critical Care and Sleep Disorders Medicine, University of Louisville, Louisville, Kentucky. Electronic address: bilaljalil@gmail.com.
[Ti] Título:Comparing Changes in Carotid Flow Time and Stroke Volume Induced by Passive Leg Raising.
[So] Source:Am J Med Sci;355(2):168-173, 2018 Feb.
[Is] ISSN:1538-2990
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Determining volume responsiveness in critically ill patients is challenging. We sought to determine if passive leg raise (PLR) induced changes in pulsed wave Doppler of the carotid artery flow time could predict fluid responsiveness in critically ill patients. MATERIALS AND METHODS: Medical intensive care unit patients ≥18 years old with a radial arterial line and FloTrac/Vigileo monitor in place were enrolled. Pulsed wave Doppler of the carotid artery was performed to measure the change in carotid flow time (CFT ) in response to a PLR. Patients were categorized as fluid responders if stroke volume increased by ≥15% on a Vigileo monitor. The main outcome measure was the accuracy of CFT to detect a change in response to a PLR. We also calculated the percentage increase in CFT that could predict fluid responsiveness. RESULTS: We enrolled 22 patients. Using an increase of ≥24.6% in the CFT in response to PLR to predict fluid responsiveness there was a sensitivity of 60%, specificity of 92%, positive likelihood ratio of 7.2, negative likelihood ratio of 0.4, positive predictive value of 86%, negative predictive value of 73% and receiver operating characteristic of 0.75 (95% CI: 0.54-0.96). CONCLUSIONS: CFT performs well compared to stroke volume measurements on a Vigileo monitor. The use of CFT is highlighted in resource-limited environments and when time limits the use of other methods. CFTc should be validated in a larger study with more operators against a variety of hemodynamic monitors.
[Mh] Termos MeSH primário: Artérias Carótidas/diagnóstico por imagem
Artérias Carótidas/fisiopatologia
Unidades de Terapia Intensiva
Postura
Volume Sistólico
Ultrassonografia Doppler de Pulso
[Mh] Termos MeSH secundário: Idoso
Velocidade do Fluxo Sanguíneo
Estado Terminal
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180207
[St] Status:MEDLINE



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