119 results match your criteria: "University of Alberta and Alberta Health Services[Affiliation]"
Postoperative oliguria after intermediate and high-risk surgeries in critical care, A cohort analysis.
J Crit Care
February 2025
General ICU, Hospital Vila Nova Star - Rede D'OR, São Luiz, Brazil; Oncological ICU, Hospital São Luiz Itaim - Rede D'OR, São Luiz, Brazil; Nephrology department, ABC medical school, Av. Lauro Gomes, 2000 - Santo André - SP, 09060-870, Brazil; Research and teaching institute - Rede D'OR, São Paulo, Brazil. Electronic address:
Article Synopsis
- Oliguria, a condition characterized by decreased urine output, may be misinterpreted as acute kidney injury (AKI) in patients post-surgery, despite being a potential adaptive response during surgery.
- A study analyzing 1,476 patients revealed that 34.4% exhibited oliguria within the first 24 hours after surgery, with certain factors like vasopressor use and non-elective procedures linked to increased risk.
- Although oliguria was associated with a higher rate of AKI development compared to non-oliguric patients, 87.6% of oliguric patients did not show kidney dysfunction based on serum creatinine levels, questioning the accuracy of oliguria as an indicator for AKI.
Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections.
N Engl J Med
November 2024
From the Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (N.D.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (A.R.), the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (R. Pinto); the Department of Infectious Diseases, Monash University, Clayton, Melbourne, VIC, Australia (B.A.R.), the Department of Intensive Care, Monash Medical Centre, Melbourne, VIC, Australia (Y.S.); the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand (R. Parke); the Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada (D.C.); the Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Y.A.); the Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada (J. Muscedere), the Department of Critical Care Medicine, Royal Columbian Hospital, Vancouver, BC, Canada (S. Reynolds), Critical Care Medicine, Capital District Health Authority, Dalhousie University, Halifax, NS, Canada (R.H.); Monash Medical Centre, Clayton, VIC, Australia (D.B.D.); Critical Care Medicine, Auckland City Hospital, New Zealand (C. McArthur), the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand. (S. McGuinness); the Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, and Faculty of medicine, Ramat-Aviv, Tel-Aviv, Israel (D.Y.); Infectious Diseases, University Health Network, University of Toronto, Toronto (B.C.); Critical Care Medicine, North York General Hospital, Toronto (A.G., P.S.), Infectious Diseases, North York General Hospital, Toronto (P. Das), Critical Care Medicine, Mount Sinai Hospital, Unity Health Toronto, Toronto (M. Detsky), the Department of Medicine, University of Toronto, Toronto (A.M.); Sinai Health, Division of General Internal Medicine, Toronto, Toronto (M.F.), Infectious Diseases, Michael Garron Hospital, University of Toronto, Toronto (J.E.P.), Infectious Diseases, Michael Garron Hospital, Toronto (C. Kandel), Critical Care Medicine and Infectious Diseases, University of Alberta, Edmonton, Canada (W.S.), Department of Critical Care Medicine, University of Alberta and Alberta Health Services, Edmonton, Canada (S.M.B.), the Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada (N.S.), the Department of Anaesthesia, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada (E.B.-C.), the Faculty of Health Sciences, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada (R.W.), the Departments of Surgery and Critical Care, McGill University Health Center, Montreal (K.K.); the Departments of Infectious Diseases and Pathology, Middlemore hospital, University of Auckland, New Zealand (S. Morpeth), Organ Donation New Zealand, New Zealand Blood Service, Auckland, New Zealand (A. Kazemi), Intensive Care Medicine, Middlemore Hospital, Auckland, New Zealand (A.W.); the Division of Infectious Diseases, Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa (D.R.M.), the Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa (L.M.), Niagara Health Knowledge Institute, Niagara Health, St. Catharines, ON, Canada (J.T.), the Department of Medicine, Université de Sherbrooke, QC, Canada (F. Lamontagne); the Department of Microbiology and Infectious Diseases, Université de Sherbrooke, QC, Canada (A.C.), Surgery and Critical Care Medicine, Unity Health Toronto, University of Toronto, Toronto (J. Marshall); Critical Care and Medicine, Unity Health Toronto-St. Michael's Hospital, University of Toronto, Toronto (J.O.F.), Critical Care Medicine, Unity Health Toronto, Toronto (R.C.), the Department of Medicine, Unity Health Toronto, Toronto (M. Downing), the Department of Medicine, Infectious Diseases, Trillium Health Partners, University of Toronto, Toronto (C.G.); the School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia (J.D.); the Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada (E.D.), St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada (J.N.), the Department of Medicine (Infectious Diseases), Queen's University, Kingston, ON, Canada (G.E.); the Department of Medicine, King Faisal Specialist Hospital and Research Center, Al Faisal University, Jeddah, Saudi Arabia (B.A.), the Department of Pathology and Laboratory Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (S.A.); the Department of Medicine, University of Western Ontario, London, Canada (C. Martin); the Department of Medicine, London Health Sciences Centre, London, ON, Canada (S.E.), the Department of Medicine, Western University, London, ON, Canada (I.B.), the Department of Medicine, Université Laval, Quebec, QC, Canada (F. Lauzier), the Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada (A.T.), the Population Health and Optimal Health Practice Research Unit, Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Québec, QC, Canada (A.T.), the Department of Critical Care, University of Calgary Cumming School of Medicine, Calgary, AB, Canada (H.T.S.), the Department of Medicine, University of Calgary and Alberta Health Services (Calgary), Calgary, AB, Canada (J.C.), the Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal (E.G.M.), the Division of Infectious Diseases, Department of Medicine, McGill University, Montreal (T.C.L.); the Department Infectious Diseases, St. George Hospital, UNSW Medicine and Health, Sydney (R.S.); the Divisions of Infectious Diseases and Medical Microbiology, University of British Columbia, Vancouver, Canada (J.G.); the Intensive Care Unit, Rabin Medical Centers, Tel Aviv University, Tel Aviv, Israel (I.K.); the Intensive Care Research Programme, Medical Research Institute of New Zealand, Wellington, New Zealand (P.Y.), Medical Research Institute of New Zealand, Wellington, New Zealand. (C.L.); the Department of Infectious Diseases, Redcliffe Hospital, Redcliffe, QLD, Australia (K.O.), Infectious Diseases, Redcliffe Hospital, University of Queensland, Redcliffe, Australia (M.E.), Infectious Diseases, Sunshine Coast University Hospital, Sunshine Coast University Hospital, Birtinya, QLD, Australia (K.C.); Medicine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal (P.A.); the Department of Anaesthesia, Rotorua Hospital, Rotorua, New Zealand (U.B.); Infectious Diseases, William Osler Health System, Brampton, ON, Canada (T. Havey), Critical Care Medicine, William Osler Health System, Brampton, ON, Canada (A.B.); the Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland (J.P.); Brantford General Hospital, McMaster University, Brantford, ON, Canada (B.R.); the Intensive Care Unit, Fiona Stanley Hospital, University of Western Australia, Murdoch, WA, Australia (E.L.); the Department of Medicine, University of Manitoba, Winnipeg, Canada (S.L.), the Division of Critical Care Medicine and Infectious Diseases, Health Sciences Centre, University of Manitoba, Winnipeg, Canada (A. Kumar), the Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (R.Z.); the Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel (T. Hoffman); the Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. (D.P.); Infectious Diseases, Memorial University, St. John's, NL, Canada (P. Daley); General and Subspecialty Medicine, Grampians Health Ballarat, Ballarat, VIC, Australia (R.J.C.); Service des soins intensifs, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal (E.C.), Critical Care Medicine, CIUSSS MCQ CHAUR, University of Montreal, Montreal (J.-F.N.); Clinical Microbiology and Infection Prevention and Control, Auckland Hospital, Auckland, New Zealand (S. Roberts); the Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia (R.T.), the Department of Intensive Care Medicine, Monash University, Melbourne, VIC, Australia (S.G.); the Department of Critical Care, Island Health Authority, Royal Jubilee Hospital, British Columbia, Victoria, Canada (G.W.); Infectious Diseases, Wollongong Hospital, Wollongong, NSW, Australia (O.S.), Infectious Diseases, Wollongong Hospital, University of Wollongong, Wollongong, NSW, Australia (S. Miyakis); the Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (P. Dodek), Infectious Diseases, Richmond Hospital, Richmond, BC, Canada (C. Kwok), and the Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (R.A.F.).
Background: Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain.
Methods: In a multicenter, noninferiority trial, we randomly assigned hospitalized patients (including patients in the intensive care unit [ICU]) who had bloodstream infection to receive antibiotic treatment for 7 days or 14 days.
Health Economic Evaluation of Antimicrobial Stewardship, Procalcitonin Testing, and Rapid Blood Culture Identification in Sepsis Care: A 90-Day Model-Based, Cost-Utility Analysis.
Pharmacoecon Open
January 2025
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, 2-124 Clinical Sciences Building, 8440 112 Street NW, Edmonton, Alberta, T6G 2B7, Canada.
Objective: We evaluated the cost-effectiveness of a bundled intervention including an antimicrobial stewardship program (ASP), procalcitonin (PCT) testing, and rapid blood culture identification (BCID), compared with pre-implementation standard care in critically ill adult patients with sepsis.
Methods: We conducted a decision tree model-based cost-effectiveness analysis alongside a previously published pre- and post-implementation quality improvement study. We adopted a public Canadian healthcare payer's perspective.
COVID-19-Associated Outcomes of Critical Illness in Patients with Frailty: a Cohort Study.
Can Geriatr J
September 2024
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta and Alberta Health Services, Edmonton.
Background: Pre-admission frailty has been associated with higher hospital mortality in patients with critical illness. We aimed to measure the prevalence of frailty and its associated outcomes in patients with COVID-19 critical illness.
Methods: A historical cohort study of all adults admitted to ICU with a pneumonia diagnosis in Alberta, Canada between May 1, 2020, and October 31, 2020.
Major adverse kidney events as an endpoint in acute kidney injury trials: is it time for a RE-MAKE?
Intensive Care Med
October 2024
Department of Intensive Care and Resuscitation, The Cleveland Clinic, Cleveland, OH, USA.
Recommendations for clinical trial design in acute kidney injury from the 31st acute disease quality initiative consensus conference. A consensus statement.
Intensive Care Med
September 2024
Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA.
Purpose: Novel interventions for the prevention or treatment of acute kidney injury (AKI) are currently lacking. To facilitate the evaluation and adoption of new treatments, the use of the most appropriate design and endpoints for clinical trials in AKI is critical and yet there is little consensus regarding these issues. We aimed to develop recommendations on endpoints and trial design for studies of AKI prevention and treatment interventions based on existing data and expert consensus.
View Article and Find Full Text PDFAssociation of Age, Frailty, and Strategy for Initiation of Renal-Replacement Therapy: A Post Hoc analysis of the STARRT-Acute Kidney Injury Trial.
Blood Purif
October 2024
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Introduction: This study was designed to assess the association of age and frailty with clinical outcomes in patients with severe acute kidney injury (AKI), according to accelerated and standard renal-replacement therapy (RRT) initiation strategies in the STARRT-AKI trial.
Methods: This was a secondary analysis of an international randomized trial. Older age was defined as ≥65 years.
Recovery from Sepsis: Management beyond Acute Care.
Semin Respir Crit Care Med
August 2024
Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
Recovery from sepsis is a key global health issue, impacting 38 million sepsis survivors worldwide per year. Sepsis survivors face a wide range of physical, cognitive, and psychosocial sequelae. Readmissions to hospital following sepsis are an important driver of global healthcare utilization and cost.
View Article and Find Full Text PDFEpidemiology of Renal Replacement Therapy for Critically Ill Patients across Seven Health Jurisdictions.
Am J Nephrol
October 2024
Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Introduction: Acute kidney injury (AKI) requiring treatment with renal replacement therapy (RRT) is a common complication after admission to an intensive care unit (ICU) and is associated with significant morbidity and mortality. However, the prevalence of RRT use and the associated outcomes in critically patients across the globe are not well described. Therefore, we describe the epidemiology and outcomes of patients receiving RRT for AKI in ICUs across several large health system jurisdictions.
View Article and Find Full Text PDFImportance: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors improve outcomes in patients with type 2 diabetes, heart failure, and chronic kidney disease, but their effect on outcomes of critically ill patients with organ failure is unknown.
Objective: To determine whether the addition of dapagliflozin, an SGLT-2 inhibitor, to standard intensive care unit (ICU) care improves outcomes in a critically ill population with acute organ dysfunction.
Design, Setting, And Participants: Multicenter, randomized, open-label, clinical trial conducted at 22 ICUs in Brazil.
Factors associated with phenotypes of dyspnea in post-COVID-19 condition: a cross-sectional study.
Sci Rep
June 2024
Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, 3-111C Clinical Sciences Building, 11302 83 Ave NW, Edmonton, T6G 2G3, AB, Canada.
Article Synopsis
- Post-COVID-19 condition (PCC) involves symptoms like fatigue and dyspnea that persist for at least 3 months after COVID infection, with a study examining 1642 adults in Alberta to understand the characteristics of those experiencing dyspnea.
- Results showed that individuals with dyspnea were more likely to be female, have a higher body mass index (BMI), a history of asthma, and experience more severe symptoms and functional limitations.
- The study identified two potential phenotypes related to dyspnea: one associated with significant fatigue but normal lung function, and another with pronounced lung abnormalities, suggesting a need for tailored rehabilitation strategies based on these differences.
The clinical impact of heart failure with preserved ejection fraction in interstitial lung diseases.
Int J Tuberc Lung Dis
June 2024
Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, AB.
Prospective, randomized, controlled trial assessing the effects of a driving pressure-limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan.
Crit Care Sci
May 2024
Research Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
Background: Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear.
Objective: To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia.
Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study.
Intensive Care Med
July 2024
Department of Medicine, McGill University, Montreal, Qc, Canada.
Purpose: Frailty is common in critically ill patients but the timing and optimal method of frailty ascertainment, trajectory and relationship with care processes remain uncertain. We sought to elucidate the trajectory and care processes of frailty in critically ill patients as measured by the Clinical Frailty Scale (CFS) and Frailty Index (FI).
Methods: This is a multi-centre prospective cohort study enrolling patients ≥ 50 years old receiving life support > 24 h.
Metabolic complications in lung transplantation for cystic fibrosis - A case control study.
Heliyon
May 2024
Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada.
Background: Metabolic complications post-lung transplant are poorly understood and little is known about how these complications differ between patients with or without cystic fibrosis (pwCF and pwoCF). This study compared post-lung transplant outcomes between pwCF and pwoCF relating to survival and incidence of diabetes, dyslipidaemia, hypertension, and renal impairment.
Methods: A retrospective (2004-2017) case-control study involving 90 pwCF and 90 pwoCF (age, sex and year of transplant matched) was conducted.
Hemoadsorption: consensus report of the 30th Acute Disease Quality Initiative workgroup.
Nephrol Dial Transplant
November 2024
Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany; and Outcomes Research Consortium, Cleveland, OH, USA.
Adsorption-based extracorporeal therapies have been subject to technical developments and clinical application for close to five decades. More recently, new technological developments in membrane and sorbent manipulation have made it possible to deliver more biocompatible extracorporeal adsorption therapies to patients with a variety of conditions. There are several key rationales based on physicochemical principles and clinical considerations that justify the application and investigation of such therapies as evidenced by multiple ex vivo, experimental and clinical observations.
View Article and Find Full Text PDFAssociation between arterial oxygen and mortality across critically ill patients with hematologic malignancies: results from an international collaborative network.
Intensive Care Med
May 2024
Interdepartmental Division of Critical Care Medicine, Sinai Health System/University Health Network, University of Toronto, Toronto, Canada.
Article Synopsis
- Patients with hematological malignancies face high risks of serious complications, and this study aimed to assess how hyperoxemia (high levels of oxygen in the blood) impacts mortality rates within 28 days in critically ill individuals.
- An analysis of data from over 11,000 patients revealed a U-shaped relationship between arterial oxygen levels (PaO) and mortality, indicating that both low and high oxygen levels can increase the risk of death.
- The study found that excessive use of oxygen was significantly linked to increased mortality rates, especially in certain patient groups, highlighting the importance of careful oxygen management in these critically ill patients.
"A Mighty Flame Can Follow a Tiny Spark": Is This the Case of c-Jun N-Terminal Kinase 1 Inhibitors in Idiopathic Pulmonary Fibrosis?
Am J Respir Crit Care Med
August 2024
Faculty of Medicine and Dentistry University of Alberta and Alberta Health Services Edmonton, Alberta, Canada.
Quantifying the Impact of Alternative Definitions of Sepsis-Associated Acute Kidney Injury on its Incidence and Outcomes: A Systematic Review and Meta-Analysis.
Crit Care Med
August 2024
Critical Care Program, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Kensington, NSW, Australia.
Article Synopsis
- - The study aimed to estimate the incidence and outcomes of sepsis-associated acute kidney injury (SA-AKI) in ICU patients while examining how different definitions of SA-AKI affect these estimates.
- - Analyzing data from 189 studies, the research found that 40% of ICU patients with sepsis developed SA-AKI, with rates varying significantly based on the definition used, ranging from 26% to 57%.
- - Among participants with SA-AKI, about 48% had died by the study's end, while 10% of survivors remained dependent on dialysis, highlighting the serious complications associated with SA-AKI in ICU settings.
Sepsis-associated acute kidney injury: recent advances in enrichment strategies, sub-phenotyping and clinical trials.
Crit Care
March 2024
Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK.
Acute kidney injury (AKI) often complicates sepsis and is associated with high morbidity and mortality. In recent years, several important clinical trials have improved our understanding of sepsis-associated AKI (SA-AKI) and impacted clinical care. Advances in sub-phenotyping of sepsis and AKI and clinical trial design offer unprecedented opportunities to fill gaps in knowledge and generate better evidence for improving the outcome of critically ill patients with SA-AKI.
View Article and Find Full Text PDFHierarchical endpoints in critical care: A post-hoc exploratory analysis of the standard versus accelerated initiation of renal-replacement therapy in acute kidney injury and the intensity of continuous renal-replacement therapy in critically ill patients trials.
J Crit Care
August 2024
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada. Electronic address:
Purpose: To perform a post-hoc reanalysis of the Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) and the Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients (RENAL) trials through hierarchical composite endpoint analysis using win ratio (WR).
Material And Methods: All patients with complete information from the STARRT-AKI (which compared accelerated versus standard approaches for renal replacement therapy - RRT initiation) and RENAL (which compared two different RRT doses in critically ill patients) trials were selected. WR was defined as a hierarchical composite endpoint using 90-day mortality, RRT dependency at 90-days, intensive care unit (ICU) length-of-stay (LOS), and hospital LOS (primary analysis); values above the unit represent a benefit of the intervention for the hierarchical composite endpoint.
Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis.
Crit Care Explor
February 2024
Department of Critical Care Medicine, King's College London, Guy's & St Thomas' Hospital, London, United Kingdom.
Objectives: Among patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant.
Design: Secondary post hoc analysis of the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial (ClinicalTrials.
Achieving Goals of Care Decisions in Chronic Critical Illness: A Multi-Institutional Qualitative Study.
Chest
July 2024
Program on Ethics and Decision Making, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Background: Physicians, patients, and families alike perceive a need to improve how goals of care (GOC) decisions occur in chronic critical illness (CCI), but little is currently known about this decision-making process.
Research Question: How do intensivists from various health systems facilitate decision-making about GOC for patients with CCI? What are barriers to, and facilitators of, this decision-making process?
Study Design And Methods: We conducted semistructured interviews with a purposeful sample of intensivists from the United States and Canada using a mental models approach adapted from decision science. We analyzed transcripts inductively using qualitative description.
Outcomes of Prophylactic Peritoneal Dialysis Catheter Insertion in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.
Pediatr Crit Care Med
June 2024
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada.
Objectives: The objective of this Prospective Register of Systematic Reviews (CRD42022384192) registered systematic review and meta-analysis was to determine whether prophylactic peritoneal dialysis (PD) catheter insertion at the time of pediatric cardiac surgery is associated with improved short-term outcomes.
Data Sources: Databases search of the MEDLINE, EMBASE, CINAHL, and Cochrane Library completed in April 2021 and updated October 2023.
Study Selection: Two reviewers independently completed study selection, data extraction, and bias assessment.
The trajectory of very old critically ill patients.
Intensive Care Med
February 2024
Department of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany.
Article Synopsis
- The healthcare system needs to rethink how it treats very old patients (over 80 years) who are seriously ill, especially due to changes in population and finances.
- It's important to include doctors, patients, and their families in decisions about care so that resources are used wisely without doing too much or too little.
- This review offers ideas from experts to help make better decisions before, during, and after ICU care, focusing on improving the patient's quality of life instead of just preventing death.