Critical care science最新文献

Objective: Implementing the Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) decision support tool for structured intensive care unit admission and rounding was associated with an increased adherence to best care practices. We determined whether this association was patient sex-dependent.

Design: Post hoc analysis of CERTAIN.

Setting: prospective multinational quality improvement study.

Patients: Adult patients admitted to one of the participating intensive care units.

Interventions: Implementation of the CERTAIN decision support tool.

Measurements: We compared incidence rates of omission of delivery of ten best care practices, including deep vein thrombosis and peptic ulcer prophylaxis, head of bed elevation, daily oral care, spontaneous breathing trials, family conferences, assessment of need for central lines and urinary catheters, and prescription of antimicrobials and sedation, between sexes, before and after implementation of the decision support tool. In addition, we determined whether sex differences existed amongst high-and middle-income countries.

Main results: CERTAIN comprised a total of 4,256 patients, with 588 females and 859 males before the implementation of the decision support tool and 1,169 females and 1,640 males after its implementation. Overall, there was no notable difference in care between sexes, neither before nor after implementation, and both sexes in high-income and middle-income countries experienced equal benefits from checklist implementation.

Conclusion: The impact of a clinical decision support tool for structured intensive care unit admission and rounding on adherence to best care practices showed minimal variation between sexes.

Objective: To evaluate how secular changes in tidal volume and respiratory rate influence the mechanical power of ventilation during the first 24 hours in critically ill patients over two decades and to compare their effects in patients with high and low respiratory system compliance.

Methods: This secondary analysis of the Amsterdam University Medical Center database included two time periods: 2003 to 2009 and 2010 to 2016. The primary endpoint was mechanical power. Analyses also assessed secular changes in mechanical power in patients with respiratory system compliance groups.

Results: Among 4,877 patients (2,536 patients in 2003 - 2009, and 2,341 in 2010 - 2016), median tidal volume decreased (mean difference of -0.6 [-0.4 to -0.7] mL/kg predicted body weight; p < 0.01), median respiratory rate increased (mean difference of +1.0 [+0.75 to +1.25] breath/minute; p < 0.01), and median mechanical power fell from 12.1 (8.7 - 16.7) J/minute to 10.4 (7.6 - 14.6) J/minute (mean difference of -1.7 [-1.2 to -2.0] J/minute; p < 0.01). In patients with low respiratory system compliance, median mechanical power decreased more significantly (13.4 J/minute to 11.7 J/minute, mean difference of -1.7 J/minute; p < 0.01) compared to those with high respiratory system compliance (10.5 J/minute to 9.7 J/minute, mean difference of -0.8 J/minute; p < 0.01) despite comparable respiratory rate changes.

Conclusion: In this single-center cohort, secular changes in tidal volume and respiratory rate were associated with lower mechanical power, particularly in patients with low respiratory system compliance.

Objective: To map the development and implementation of competency-based education in intensive care multiprofessional training on the basis of national and international literature.

Methods: A scoping review was conducted with searches in six databases and gray literature.

Results: The initial search identified 1,636 potentially eligible records, and 31 studies were included in the final sample. The data were grouped into three themes: development of competency-based education, implementation of competency-based education in curricula, continuing education and training programs, and student assessment. The studies were published between 2000 and 2024 and focused primarily on medical education, with a predominance of publications from North America and Europe. Heterogeneity was identified in the conceptual strategies of competency-based education, with an initial focus on skill lists evolving into core competencies, milestones, and entrustable professional activities. Benefits such as transparency in the learning process, individualized tracking, and the promotion of reflective learning were identified. Challenges to implementing effective competency-based education include the need for faculty training, resistance to change, a lack of time and resources, and the development of more robust assessment tools. The lack of studies on competency-based education in Latin America and the reduced number of studies in other health fields, such as nursing and physiotherapy, were highlighted.

Conclusion: Competency-based education appears promising for training in intensive care; however, further research is needed to assess its impact on quality of care and patient safety, as well as to broaden the discussion to include diverse contexts and health fields.

The PROtective VEntilation (PROVE) Network is a globally-recognized collaborative research group dedicated to advancing research, education, and collaboration in the field of mechanical ventilation. Established to address critical questions in intraoperative and intensive care ventilation, the network focuses on improving outcomes for patients undergoing mechanical ventilation in diverse settings, including operating rooms, intensive care units, burn units, and resource-limited environments in low- and middle-income countries. The PROVE Network is committed to generating high-quality evidence through a comprehensive portfolio of investigations, including randomized clinical trials, observational research, and meta-analyses. Its work has significantly contributed to understanding optimal ventilation strategies in critically ill patients, such as those with COVID-19, and in exploring innovative approaches like closed-loop ventilation systems. The network has spearheaded pioneering studies that have shaped clinical practice worldwide by integrating expertise from a wide range of disciplines. A defining feature of the PROVE Network is its emphasis on mentorship and collaboration. It fosters a supportive environment where junior researchers are guided by experienced mentors, ensuring the transfer of knowledge and promoting inclusivity. The network prioritizes gender balance and diversity, recognizing the value of varied perspectives in driving meaningful innovation and advancing research excellence. This paper reviews the history, key projects, and leadership of the PROVE Network, highlighting its impactful contributions to the field of mechanical ventilation. By uniting researchers globally, the PROVE Network exemplifies the power of collaboration in addressing complex clinical challenges, including personalized ventilation and the use of Artificial Intelligence, and improving patient care.

Objective: To develop a score (Palineo score) to identify the palliative care needs of newborn patients admitted to a Brazilian neonatal intensive care unit of a tertiary maternity hospital that serves as a reference center for high-risk pregnancies, ensuring timely follow-up by a specialist.

Methods: Patients were assessed by three specialists using a questionnaire that included the same clinical elements as those used for the Palineo score but did not assign scores to the criteria. The score was determined by the consensus reached by the specialists. A score was subsequently assigned to each component of the Palineo score, allowing for comparisons between the specialists' assessments and the Palineo score. All the information was retrospectively obtained from the electronic medical records. Data were collected and evaluated on the third and seventh days of life and then weekly until discharge from the neonatal intensive care unit, transfer to another service, or death. The Palineo score was applied to each patient to establish discriminatory cutoff points for the classifications initially assigned by the specialists.

Results: The score showed agreement across the evaluations (k = 0.85). The discriminant values of the Palineo score between patients classified as palliative intent and associated palliative care revealed exceptional accuracy for both the first application of the score (p < 0.001) and the final application (p < 0.001). The discriminant values between patients categorized as associated palliative care and those categorized as specialized palliative care showed exceptional accuracy for the first application (p = 0.005) and final application (p < 0.001) of the score.

Conclusion: Despite exceptional accuracy, discrepant values should be considered with caution. This study should be replicated in a larger sample.