Abstract:
PURPOSE:The purpose of this article was to determine the extent to which patients at high risk of hospital death who undergo cardiopulmonary resuscitation (CPR) have previously had their life support preferences addressed and documented. MATERIALS AND METHODS:We conducted a retrospective chart review of all patients older than 18 years of age hospitalized for more than 24 hours who sustained a cardiac arrest with attempted CPR at our tertiary care university teaching hospital during 1994 (n = 71). We searched all hospital charts specifying ICD-9 codes: Cardiac arrest, ventricular fibrillation, ventricular tachycardia, asystole, electromechanical dissociation, defibrillation, or CPR. Patients were selected if (1) they had a true cardiac arrest (abrupt cessation of spontaneous circulation) and (2) had attempted CPR or defibrillation. Patients were classified as "high risk" if they satisfied at least one of the following: modified prearrest morbidity index > or = 7, moderate/severe dementia, day 1 APACHE II score > 24 or > or = 4 dysfunctional organ systems. RESULTS:We searched 147 charts; of 71 patients meeting inclusion criteria, 53 were high risk. Of patients at high risk of sustaining a cardiopulmonary arrest during the index hospital admission, 3 (6%) had preferences addressed within the first 24 hours of hospitalization, 7 (13%) had delayed discussion of preferences before arrest, 23 (43%) had preferences addressed post arrest, and 20 (38%) had no documented discussions. Of the 23 high-risk patients initially surviving cardiac arrest, all were subsequently given "do not resuscitate" orders. Univariate analysis of factors associated with life-support discussion before cardiac arrest were previous cardiac arrest (OR, 5.9) and APACHE II score > 24 (OR, 1.1), although neither reached statistical significance. None of the 32 patients with a modified PAM index > or = 7 (32 of 71) survived hospitalization. Only 3 patients survived to hospital discharge. CONCLUSIONS:Early communication regarding life-support preferences is important in high-risk patients so that inappropriate or unwanted treatment is not implemented. Given that optimal care includes addressing and documenting life-support preferences in high-risk patients early in their hospitalization, this standard was infrequently met.
journal_name
J Crit Carejournal_title
Journal of critical careauthors
Kernerman P,Cook DJ,Griffith LEdoi
10.1016/s0883-9441(97)90026-5subject
Has Abstractpub_date
1997-12-01 00:00:00pages
155-60issue
4eissn
0883-9441issn
1557-8615pii
S0883-9441(97)90026-5journal_volume
12pub_type
杂志文章abstract:PURPOSE:Optimal dosing of antibiotics is important for efficacy and avoidance of resistance. Fluoroquinolones are frequently used to treat severe infections in critically ill patients. We studied ciprofloxacin pharmacokinetics after administration of 400 mg twice a day (bid) intravenously (IV). MATERIAL AND METHODS:Se...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2007.11.011
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:Quality improvement (QI) is a central tenant of trauma center accreditation in most countries, but its effectiveness is largely unknown. We sought to explore opportunities for improving trauma QI. METHODS:We performed a qualitative research study using grounded theory analyses of interviews with medical dir...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2012.07.010
更新日期:2012-12-01 00:00:00
abstract:PURPOSE:The primary objective of this survey was to describe pharmacists' attitudes regarding probiotic use in the intensive care unit (ICU); secondary objectives were to evaluate pharmacists' knowledge and use of probiotics for critically ill patients. METHODS:The survey instrument was rigorously designed and pretest...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2015.10.016
更新日期:2016-02-01 00:00:00
abstract:INTRODUCTION:Ventilator-associated pneumonia (VAP) is difficult to diagnose. Recent data suggest quantitative endotracheal aspirate (ETA) may be noninferior diagnostically to quantitative bronchoalveolar lavage (BAL). We hypothesized this would be the case. METHODS:Blind quantitative ETA and BAL were performed on 150 ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2008.06.012
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:Resident physicians' beliefs about cardiopulmonary resuscitation (CPR) may impact their communication with patients about end-of-life care. We sought to understand how these perceptions and experiences have changed in the past decade because both medical education and American society have focused more on th...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2007.12.012
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:The objectives of this study were to compare patients' energy expenditure (EE) during pressure support (PS) and T-tube (TT) weaning from mechanical ventilation (MV) through indirect calorimetry (IC) and to crosscheck these findings with the results calculated using Harris-Benedict (HB) equation. METHODS:Thi...
journal_title:Journal of critical care
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jcrc.2010.05.032
更新日期:2011-02-01 00:00:00
abstract:PURPOSE:The purpose of this study is to determine if monitoring urinary bladder PCO2, PO2, and calculated intramucosal pH would be a reliable index of tissue perfusion. MATERIALS AND METHODS:This nonrandomized controlled study was conducted in a laboratory at a university medical center. Eight immature female Yorkshir...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/s0883-9441(99)90020-5
更新日期:1999-06-01 00:00:00
abstract:BACKGROUND:Intensive care unit (ICU) physicians should provide relatives of critically ill patients with appropriate and clear information, regarding prognosis, treatment options and expectations. OBJECTIVES:To assess whether a structured communication tool improves satisfaction with care and engenders realistic expec...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2019.01.011
更新日期:2019-06-01 00:00:00
abstract:PURPOSE:Prophylactic laxative regimens may prevent constipation but may increase diarrhea and subsequent rectal tube insertion. Our aim was to compare three prophylactic laxative regimens on the rate of rectal tube insertion (primary outcome) and major constipation- or diarrhea-associated complications. MATERIAL AND M...
journal_title:Journal of critical care
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jcrc.2019.04.010
更新日期:2019-08-01 00:00:00
abstract:PURPOSE:Sepsis damages the endothelial glycocalyx, contributing to fluid extravasation, organ injury, and death. Our goal was to determine if syndecan-1 level is associated with the risk of intubation and modifying effect of intravenous fluids (IVFs) in these patients. METHODS:Syndecan-1 was measured at enrollment in ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2016.06.027
更新日期:2016-12-01 00:00:00
abstract:PURPOSE:This study was undertaken to assess recent trends of the choice of renal replacement therapy (RRT) modalities in Japanese intensive care units (ICUs). MATERIALS AND METHODS:Data were extracted from the Japanese Diagnosis Procedure Combination database for 2011. We identified adult patients without end-stage re...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2014.11.003
更新日期:2015-04-01 00:00:00
abstract:PURPOSE:A retrospective analysis of critically-ill patients with hypoxic hepatitis (HH) to characterize the biochemical profile and to identify predictors of mortality using the Medical Information Mart for Intensive Care III database. METHODS:HH was defined as a rapid increase in AST/ALT≥800IU/L after exclusion of ot...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2017.04.040
更新日期:2017-10-01 00:00:00
abstract:PURPOSE:To determine the neurologic outcome of patients with intracranial hypertension treated with barbiturate-induced coma. MATERIALS AND METHODS:The records of 49 patients who were admitted to a 31-bed medicosurgical intensive care unit over a 5-year period in whom a barbiturate coma was induced to control intracra...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1053/jcrc.2002.33032
更新日期:2002-03-01 00:00:00
abstract:PURPOSE:We hypothesized that the predictability of stroke volume variation (SVV) on fluid responsiveness would be reduced in patients with coronary disease who have wide pulse pressure (PP). METHODS:Sixty-six patients undergoing coronary surgery were divided into 2 groups according to the PP measured 1 day before surg...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2012.09.011
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:To determine whether the systolic fraction (SF) of the pulmonary venous flow (PVF), measured by transesophageal echocardiography (TEE) could be used to estimate the pulmonary artery occlusion pressure (PAOP). DESIGN:Prospective clinical investigation. PATIENTS:Nineteen intubated patients with ARDS. INTERVE...
journal_title:Journal of critical care
pub_type: 临床试验,杂志文章
doi:10.1016/j.jcrc.2004.07.009
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND:Selective digestive decontamination of the digestive tract involves the routine administration of oral, gastric, and intravenous antibiotics to mechanically ventilated children to prevent hospital-acquired infections. It has a strong evidence base in adults, with limited pediatric evidence. Current utilizati...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2017.02.024
更新日期:2017-06-01 00:00:00
abstract::Critical care physicians may hear a surrogate decision-maker ask, "What would you do if she was your mother?" or "What if your father was this sick?" These kinds of questions ask more of the critical care physician than the surrogate might realize. There are deep-seated ethical, professional, and personal complexities...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2018.10.031
更新日期:2019-02-01 00:00:00
abstract:PURPOSE:To identify early mortality-associated clinical risk factors preceding, during, and after cardiac surgery in children. MATERIALS AND METHODS:Of the 722 children admitted to our pediatric intensive care unit (PICU) from January 1992 to January 1997 after repair of congenital heart defects, 70 required 48 hours ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1053/jcrc.2002.36760
更新日期:2002-12-01 00:00:00
abstract:HYPOTHESIS:As vasopressin is a small peptide, its sieving coefficient (SC) and clearance (CL) during continuous renal replacement therapy may be intermediate to those for urea and β2 microglobulin (commonly used markers for small- and middle-molecular weight solutes, respectively). METHODS:A prospective, minimal-risk ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2010.03.005
更新日期:2010-12-01 00:00:00
abstract:PURPOSE:Survivors of critical illness are frequently unable to return to their premorbid level of psychocognitive functioning following discharge. Therefore, we aimed to evaluate the burden of psychological trauma experienced by patients in the intensive care unit (ICU) as perceived by clinicians to assess factors that...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2016.09.008
更新日期:2017-02-01 00:00:00
abstract::The concept of permissive hypotension is a controversial topic in trauma care. While driving blood pressure to "normal" levels with large volume crystalloid infusions is not appropriate, definitive data on the target blood pressure for hypotensive resuscitation are lacking. Indeed, the concept of systolic blood pressu...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2013.11.017
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:The Montpellier protocol for intubating patients in the intensive care unit (ICU) is associated with a decrease in intubation-related complications. We sought to determine if implementation of a simplified version of the Montpellier protocol that removed selected components and allowed for a variety of pre-o...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2017.11.014
更新日期:2018-04-01 00:00:00
abstract:PURPOSE:When radiologists are not available, chest radiographs (CXRs) of pediatric intensive care unit (PICU) patients are commonly interpreted by pediatric intensivists. We prospectively investigated the frequency of errors in CXR interpretation by pediatric intensivists and their impact on patient management. MATERI...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2009.05.016
更新日期:2010-06-01 00:00:00
abstract:PURPOSE:The response to inhaled nitric oxide (iNO) is inconsistent in patients with acute respiratory distress syndrome (ARDS). We sought to determine whether the response to iNO, defined as 20% Pao(2)/Fio(2) increase from baseline, depends on the level of cardiac natriuretic peptides. MATERIALS AND METHODS:This is a ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2008.10.014
更新日期:2010-03-01 00:00:00
abstract:PURPOSE:The purpose of the study is to describe the role of human metapneumovirus (hMPV) infection in critical illness and acute respiratory distress syndrome (ARDS). MATERIALS AND METHODS:We collected clinical and demographic information from a retrospective chart review, comparing patients with and without an intens...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2015.09.035
更新日期:2016-02-01 00:00:00
abstract:PURPOSE:The ability of the global end-diastolic volume index (GEDVI) and respiratory variations in left ventricular outflow tract velocity (ΔVTI(LVOT)) for prediction of fluid responsiveness is still under debate. The aim of the present study was to challenge the predictive power of GEDVI and ΔVTI(LVOT) compared with p...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2011.07.073
更新日期:2012-06-01 00:00:00
abstract::Complex microbial communities within the human body, constituting the microbiome, have a broad impact on human health and disease. A growing body of research now examines the role of the microbiome in patients with critical illness, such as sepsis and acute respiratory failure. In this article, we provide an introduct...
journal_title:Journal of critical care
pub_type: 杂志文章,评审
doi:10.1016/j.jcrc.2016.09.029
更新日期:2017-04-01 00:00:00
abstract:PURPOSE:To evaluate the predictive value of 6 different biomarkers in the development of multiple-organ failure (MOF) and mortality in a contemporary prospective cohort of acute respiratory distress syndrome (ARDS). METHODS:Patients with ARDS admitted to a tertiary referral center during an 8-month period were include...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2014.09.001
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVES:In certain populations, social, legal, and religious factors may influence end-of-life decisions in ventilator-dependent patients. This study aims to evaluate attitudes of first-degree relatives of chronically ventilated patients in Israel, toward end-of-life decisions regarding their loved ones, themselves,...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2009.01.011
更新日期:2009-06-01 00:00:00
abstract:PURPOSE:The criteria for starting extracorporeal membrane oxygenation (ECMO) therapy in term newborn patients with hypoxemic respiratory failure consist of an oxygenation index (OI) of 25 or higher and alveolar-arterial oxygen (Aao(2)) gradient of more than 600 at sea level. In such conditions, inhaled nitric oxide (iN...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2005.05.011
更新日期:2005-09-01 00:00:00