Reducing Mortality in Critically Ill Patients


Book Description

The 2nd edition of this book describes the recent techniques, strategies, and drugs that have been demonstrated by multicenter randomized trials to influence survival in critically ill, defined as those who have acute failure of at least one organ, due to either a pathological condition or a medical intervention, and require intensive care treatment. Each chapter focuses on a specific procedure, device, or drug. The scope is accordingly wide, with coverage of topics as diverse as noninvasive mechanical ventilation, protective ventilation, prone positioning, intravenous salbutamol in ARDS, high-frequency oscillatory ventilation, mild hypothermia after cardiac arrest, daily interruption of sedatives, tranexamic acid, diaspirin cross-linked hemoglobin, albumin, growth hormone, glutamine supplementation, tight glucose control, supranormal oxygen delivery, and hydroxyethyl starch in sepsis. The topics selection was performed with the help of hundreds of specialists from dozens of countries; they expressed via web if they agreed or not with these topics and if they used them in their daily clinical practice. The clear text is supported by "how to do" sections and "key point" boxes that provide easily accessible practical information. Written by acknowledged international experts, Reducing Mortality in Critically Ill Patients is of interest for a wide variety of specialists, including intensivists, emergency doctors, and anesthesiologists.




Reducing Mortality in Acute Kidney Injury


Book Description

This book describes the techniques, strategies, and drugs that have been demonstrated by at least one paper published in a peer-reviewed journal to significantly influence survival in patients with or at risk for acute kidney injury. Each chapter focuses on a specific intervention. The scope is accordingly wide, with coverage of topics as diverse as the type, timing, and dose of renal replacement therapy (RRT), anticoagulation and specific indications for RRT, perioperative hemodynamic optimization, fluid balance, diuretics, colloids, fenoldopam, terlipressin, N-acetylcysteine, and vasopressin. A variety of settings are considered, including critically ill patients, cardiac surgery, and hepatic and hematologic disorders. The topic selection was made using a democracy-based approach in which hundreds of specialists from dozens of countries expressed, via the web, whether they agreed with these topics and whether they used the techniques in their daily clinical practice. The clear text is supported by "how to do" sections and "key point" boxes that provide easily accessible practical information. The book will be of interest for a wide variety of specialists, including intensivists, nephrologists, emergency doctors, and anesthesiologists.




Reducing Mortality in the Perioperative Period


Book Description

This second edition presents the first update on a consensus process during which all evidence from the literature with a survival benefit in the perioperative period was gathered, and in which 500 physicians from 61 countries worked to confirm the findings. Perioperative morbidity and mortality currently represent a public health problem, as mortality alone is 1-4% in Western countries. Surprisingly, randomized evidence of survival benefit in the perioperative period is available for only 12 topics, while two drugs have been demonstrated to increase mortality. This book offers a complete description of each topic with updated evidence from the literature. Each chapter deals with a specific drug or technique and is structured into the following: background knowledge, main evidence from the literature, and a practical how-to section. Lastly, the book describes in detail the consensus process used, which served to reinforce the systematic review and which is currently being used and improved in other settings with growing success. Written by respected international experts, Reducing Mortality in the Perioperative Period, 2nd ed. will be of interest to a wide variety of specialists, including anesthesiologists, intensivists, surgeons and cardiologists.




ICU Protocols


Book Description

The book describes step-wise management of clinical emergencies seen every day in Intensive care units (ICUs. As a practical guide, clinicians can refer to it on a day-to-day basis during their work hours, or while in transit to update their knowledge. Targeted readers are intensivists, critical care specialists, and residents involved in the care of patients admitted in ICUs. This handbook covers an array of specialities such as cardiology, pulmonology, gastroenterology, neurology, nephrology, traumatology, and toxicology. This monograph provides point-of-care treatment guidance and will serve as a ready-reckoner for physicians to quickly learn the management steps in a methodical manner.




Strategies to Reduce Hospital Mortality in Lower and Middle Income Countries (LMICs) and Resource-Limited Settings


Book Description

This book examines experiences in resource-limited settings, including Low- and Middle-Income Countries (LMICs) and covers a mix of strategies to reduce hospital mortality in these settings. These include population-level and clinical interventions such as health literacy; clinical management guidelines around nutrition; guidelines and protocols for a multi-disciplinary team approach for surgical care; and improving hospital outcomes for elderly patients. The authors argue that robust quality-of-care systems, driven by evidence-based models/frameworks, are relevant in the matrix of solutions. Clinicians, health administrators, policy makers, academics, and students of public health and related disciplines should critically examine these strategies, inclusive of policy and programmatic interventions to reduce hospital mortality across the demographic spectrum in LMICs and other resource-limited settings.




Surviving Intensive Care


Book Description

For many years, intensive care has focused on avoiding immediate death from acute, life-threatening conditions. However, there are increasing reports of a number of lingering consequences for those who do indeed survive intensive care. Examples include on-going high risk of death, neurocognitive defects, significant caregiver burden, and continued high healthcare costs. Surviving Intensive Care, written by the world's experts in this area, is dedicated to better understanding the consequences of surviving intensive care and is intended to provide a synopsis of the current knowledge and a stimulus for future research and improved care of the critically ill.







On the Mend


Book Description




Evidence-Based Practice of Critical Care E-Book


Book Description

Evidence-Based Practice of Critical Care, 2nd Edition, presents objective data and expert guidance on managing critically ill patients in unique question-based chapters that focus on best practices. Now thoroughly updated by Drs. Clifford S. Deutschman, Patrick J. Neligan, and nearly 200 critical-care experts, this highly regarded title remains the only book of its kind that provides a comprehensive framework for translating evidence into practice, making it a valuable resource for both residents and practitioners. Tap into the expertise of nearly 200 critical-care experts who discuss the wide variety of clinical options in critical care, examine the relevant research, and provide recommendations based on a thorough analysis of available evidence. Think through each question in a logical, efficient manner, using a practical, consistent approach to available management options and guidelines. Find the information you need quickly with tables that summarize the available literature and recommended clinical approaches. Navigate a full range of challenges from routine care to complicated and special situations. Stay up to date with new issues and controversies such as the redefinition of sepsis • changing approaches to fluid administration • immune suppression in sepsis • monitoring the microcirculation • the long-term sequelae of critical illness • minimizing ventilator associated lung injury • the benefits of evidence-based medicine management guidelines • rapid response teams • and more. Benefit from all-new sections covering persistent critical illness and the role of advanced practice nurses and physician assistants in the ICU.




Processes and Structures of Care for Critically Ill Patients with Acute Brain Injury


Book Description

Background: Examining the differences in quality and intensity of care within the context of ICU structure is needed to better understand the mortality differences observed between centers, and may help to improve the design of future trials for this neurocritically ill patient population. Methods: This dissertation uses several methods to examine the relationship between processes, organization of care and outcome for critically ill patients with acute brain injury. Results: First in a cohort study, I evaluated the association between centers rendering early decisions to withdraw life-sustaining therapies in severe traumatic brain injury (sTBI), as measured by time until death, and overall risk-adjusted mortality. After adjustment for case mix, care in a center with a preponderance of early deaths (within the first 5 days of ICU admission) was not associated with increased odds of death (adjusted odds ratio (OR) 0.95; 95% confidence interval (CI) 0.83-1.09). Secondly in a meta-analysis, I examined the relationship between the timing of tracheostomy in acutely brain injured patients and mortality. Early tracheostomy was associated with lower long-term mortality (risk ratio [RR] 0.57. 95% CI 0.36-0.90), reduced duration of mechanical ventilation (mean difference [MD] -2.72 days, 95% CI -1.29 to -4.15) and ICU length of stay (MD -2.55 days, 95% CI -0.50 to -4.59), but, was not associated with lower short-term mortality (RR 1.25; 95% CI 0.68-2.30), and, as expected, increased the probability of ever receiving a tracheostomy (RR 1.58, 95% CI 1.24-2.02). Lastly in a cohort study combined with survey data, I examined the association between dedicated neurocritical care units, the presence of standardized management protocols for sTBI, and mortality. Care in a dedicated neurocritical care unit was not associated with a lower risk-adjusted in-hospital mortality (OR 0.97 (95% CI 0.80-1.19), but the utilization of standardized TBI management protocols for these patients was associated with lower risk-adjusted in-hospital mortality (OR 0.77; 95% CI 0.63-0.93). Conclusions: Using several analytical approaches, these findings highlight important opportunities to reduce variability in care negatively impacting on acute brain injury outcomes.