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Reimagining critical care:Trends and shifts in 21st century medicine

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World Journal of critical care Medicine 2024年第3期13卷 5-10页

作者： Sai Doppalapudi Bilal Khan Muhammad Adrish Division of Pulmonary and critical care Medicine Department of MedicineBronxCare Health System/Icahn School of Medicine at Mount SinaiBronxNY 10467United States Pulmonary William P.Clements High SchoolSugar LandTX 77479United States Section of Pulmonary and critical care Medicine Ben Taub Hospital/Baylor College of MedicineHoustonTX 77030United States

primarily driven by advancements in technology,changes in healthcare delivery,and a deeper understanding of disease *** in technology have revolutionized patient monitoring,diagnosis,and treatment in the critical care *** minimally invasive procedures to advances imaging techniques,clinicians now have access to a wide array of tools to assess and manage critically ill patients more *** this editorial we comment on the review article published by Padte S et al wherein they concisely describe the latest developments in critical care medicine.

关键词： Artificintelligenceial Ventilators Extracorporeal organ support Telemedicine critical care

Ten misconceptions regarding decision-making in critical care

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World Journal of critical care Medicine 2024年第2期13卷 72-82页

作者： Tara Ramaswamy Jamie L Sparling Marvin G Chang Edward A Bittner Department of Anesthesiology Perioperative and Pain MedicineStanford University School of MedicineStanfordCA 94305United States Department of Anesthesia Critical Care and Pain MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMA 02114United States

Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare *** complexity,illness severity,and the urgency in initiating proper treatment all contribute to decision-making ***-related factors such as fatigue,cognitive overload,and inexperience further interfere with effective *** science has provided insight into the clinical decision-making process that can be used to reduce *** evidence-based review discusses ten common misconceptions regarding critical care *** understanding how practitioners make clinical decisions and examining how errors occur,strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.

关键词： Clinical reasoning Cognitive bias critical care Debiasing strategies decision making Diagnostic reasoning Diagnostic error Heuristics Medical knowledge Patient safety

Artificial intelligence:Applications in critical care gastroenterology

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Artificial Intelligence in Gastrointestinal Endoscopy 2024年第1期5卷 1-10页

作者： Deven Juneja Department of critical care Medicine Max Super Speciality HospitalNew Delhi 110017India

Gastrointestinal(GI)complications frequently necessitate intensive care unit(ICU)***,critically ill patients also develop GI complications requiring further diagnostic and therapeutic ***,these patients form a vulnerable group,who are at risk for developing side effects and *** effort must be made to reduce invasiveness and ensure safety of interventions in ICU *** intelligence(AI)is a rapidly evolving technology with several potential applications in healthcare *** produce a large amount of data,which may be employed for creation of AI algorithms,and provide a lucrative opportunity for application of ***,the current role of AI in these patients remains limited due to lack of large-scale trials comparing the efficacy of AI with the accepted standards of care.

关键词： Artificial intelligence critical care Gastroenterology Hepatology Intensive care unit Machine learning

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

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Military Medical Research 2020年第3期7卷 283-302页

作者： Jing-Chun Song Shu-Yuan Liu Feng Zhu Ai-Qing Wen Lin-Hao Ma Wei-Qin Li Jun Wu Department of critical care Medicine the 908th Hospital of Joint Logistics Support Forces of Chinese PLANanchang 360104China Emergency Department the Sixth Medical CenterChinese PLA General HospitalBeijing 100048China Burns and Trauma ICU Changhai HospitalNaval Medical UniversityShanghai 200003China Department of Blood Transfusion Daping Hospital of Army Medical UniversityChongqing 400042China Department of Emergency and critical care Medicine Changzheng HospitalNaval Medical UniversityShanghai 200003China Surgery Intensive care Unit Jinling HospitalMedical School of Nanjing UniversityNanjing 210002China Department of Clinical Laboratory Peking University Fourth School of Clinical MedicineBeijing Jishuitan HospitalBeijing 100035China

Thrombocytopenia is a common complication of critical care *** rates of bleeding events and mortality are also significantly increased in critical care patients with ***,the critical care Medicine Committee of Chinese People’s Liberation Army(PLA)worked with Chinese Society of Laboratory Medicine,Chinese Medical Association to develop this consensus to provide guidance for clinical *** consensus includes five sections and 27 items:the definition of thrombocytopenia,etiology and pathophysiology,diagnosis and differential diagnosis,treatment and prevention.

关键词： Thrombocytopenia Adult critical care Diagnosis Treatment Expert consensus

Ten Basic Principles about critical Ultrasonography： critical care Practitioners Need to Know

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Chinese Medical Journal 2017年第13期130卷 1610-1614页

作者： Li-Na Zhang Hong-Min Zhang Yan-Gong Cao Wan-Hong Yin Wei He Ran Zhu Xin Ding Li-Xia Liu Jun Wu Li Li Hai-Tao Liu Yu-Hang Ai Xiao-Ting Wang Department of critical care Medicine Xiangya Hospital Central South University Changsha Hunan 410008 China Department of critical care Medicine Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Beijing 100730 China Department of critical care Medicine Hua Xin Hospital First Hospital of Tsinghua University Beijing 100016 China Department of critical care Medicine West China Hospital Sichuan University Chengdu Sichuan 610041 China Department of critical care Medicine Beijing Tongren Hospital Beijing 100730 China Department of critical care Medicine The First Hospital of China Medical University Shenyang Liaoning 110001 China Department of critical care Medicine The Fourth Hospital of Hebei Medical University Shijiazhuang Hebei 050011 China Department of critical care Medicine Rui Jin Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200025 China Department of critical care Medicine The Third Affiliated Hospital of Harbin Medical University Harbin Heilongjiang 150081 China

With the noninvasive, convenient, and unique value in tile quick diagnosis and dynamic monitoring during the course of treatment, critical ultrasonography has been widely used in critical care medicine, regarded as the ＂visual stethoscope＂ and applied in medical education and training system. Based on years of experience in the application and promotion of critical ultrasonography, the authors of this study suggested that a proper understanding of critical ultrasonography is of most importance, and a consistent quality control system is required to minimize misdiagnosis,

关键词： critical care critical Ultrasonography Ejection Fraction Inferior Vena Cava Velocity-time Integral

Sensorineural hearing dysfunction after discharge from critical care in adults:A retrospective observational study

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Journal of Otology 2021年第3期16卷 144-149页

作者： Takashi Fujiwara Mizuki Sato Shin-ichi Sato Toshio Fukuoka Department of Public Health Research Kurashiki Clinical Research InstituteMiwa 1-1-1Kurashiki CityOkayama Prefecture710-8602Japan Department of Otolaryngology Head and Neck Surgery Kurashiki Central HospitalMiwa 1-1-1Kurashiki CityOkayama Prefecture710-8602Japan Department of critical care and Emergency Medicine Kurashiki Central HospitalMiwa 1-1-1Kurashiki CityOkayama Prefecture710-8602Japan Emergency and critical care Center Kurashiki Central HospitalMiwa 1-1-1Kurashiki CityOkayama Prefecture710-8602Japan

Background Patients undergoing intensive care are exposed to risk factors for hearing *** study assessed the worse changes in pure tone average(PTA)thresholds after intensive care and identified the factors associated with worse hearing *** We conducted a single-centre retrospective study,and included adult patients admitted to the intensive care unit(ICU)of Kurashiki Central Hospital between January 2014 and September 2019,who had regular pure tone audiometry performed before and after ICU *** between changes in PTA threshold and patient characteristics,were *** included ears were classified as those with worse hearing(>10 dB increase in the PTA threshold)and those without worse hearing,and the baseline characteristics were *** During the study period,125 ears of 71 patients(male:female ratio,35:36;mean age,72.5±12.3 years)met the eligibility ***,sex,and the use of furosemide were not correlated with changes in PTA *** analysis showed that ears with worse hearing were associated with a lower serum platelet count than ears without worse hearing(153±85×10^(9)/L vs.206±85×10^(9)/L,respectively;P=0.010),and the rate of planned ICU admission(elective surgery)was higher in the worse hearing group(57.1% vs.28.8%,respectively;p=0.011).Conclusions Age,sex,and the use of furosemide did not have adversely affect hearing *** serum platelet count and planned admission appear to be risk factors for worse hearing.

关键词： Hearing loss critical care Intensive care Adverse effects Observational study

Disparities in employment outcomes among critical care graduates with different training backgrounds

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Emergency and critical care Medicine 2023年第4期3卷 163-170页

作者： Greg J.Eisinger Patrick J.Sylvester Dheeraj Duggineni David P.Way Jing Peng Jiang Ma Jennifer W.McCallister Matthew C.Exline Division of Pulmonary critical care and Sleep Medicine Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusOHUSA Team Health KnoxvilleTNUSA Department of Emergency Medicine The Ohio State University Wexner Medical CenterColumbusOHUSA Department of Biomedical Informatics The Ohio State UniversityColumbusOHUSA

Background:We sought to characterize the impact of critical care training pathways on subsequent employment ***:A survey assessing the postfellowship work environment and barriers to employment in a preferred setting was electronically distributed on September 16,2019,to program directors and coordinators at all US adult critical care fellowships with instructions to for-ward it to the prior year’s ***:Data collection was interrupted by the coronavirus disease 2019 ***-nine participants were included,reflecting a low rate of *** worked in urban areas(76.6%)at academic hospitals(81.7%).Graduates of internal medicine critical care(IMCC)were more likely than pulmonary critical care(PCC)to report their fellowship as a barrier to employment(50%vs 0%;Pcritical care graduates,residency in emergency medicine and fellowship in IMCC were associated with in-creased barriers to finding desired employment.

关键词： Bias critical care critical care workforce Employment medicine Employment barriers Employment opportunities Fellowship training Job market Residency training

critical care practices in the world:Results of the global intensive care unit need assessment survey 2020

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World Journal of critical care Medicine 2022年第3期11卷 169-177页

作者： Faisal A Nawaz Neha Deo Salim Surani William Maynard Martin L Gibbs Rahul Kashyap College of Medicine Mohammed Bin Rashid University of Medicine and Health SciencesDubai 505055United Arab Emirates Department of Medicine Mayo Clinic Alix School of MedicineRochesterMN 55905United States critical care Medicine Mayo ClinicRochesterMN 55905United States Texas A&M University College StationTX 77843United States Internal Medicine TriStar Centennial Medical CenterHCA HealthcareNashvilleTN 37203United States Pulmonary and critical care Tulane University School of MedicineNew OrleansLA 70112United States

BACKGROUND There is variability in intensive care unit(ICU)resources and staffing *** may reflect variation in practice and outcomes across all health *** To improve research and quality improvement measures administrative leaders can create long-term strategies by understanding the nature of ICU practices on a global *** The Global ICU Needs Assessment Research Group was formed on the basis of diversified skill *** aimed to survey sites regarding ICU type,availability of staffing,and adherence to critical care *** international survey‘Global ICU Needs Assessment’was created using Google Forms,and this was distributed from February 17^(th),2020 till September 23^(rd),*** survey was shared with ICU providers in 34 *** approaches to motivating healthcare providers were implemented in securing submissions,including use of emails,phone calls,social media applications,and WhatsApp^(TM).By completing this survey,providers gave their consent for research *** study was deemed eligible for category-2 Institutional Review Board exempt *** There were a total 121 adult/adult-pediatrics ICU responses from 34 countries in 76 cities.A majority of the ICUs were mixed medical-surgical[92(76%)].108(89%)were adult-only *** 36 respondents(29.8%)were 31-40 years of age,with 79(65%)male and 41(35%)female participants.89 were consultants(74%).A total of 71(59%)respondents reported having a 24-h inhouse intensivist.A total of 87(72%)ICUs were reported to have either a 2:1 or≥2:1 patient/nurse *** 44%of the ICUs were open and 76%were mixed type(medical-surgical).Protocols followed regularly by the ICUs included sepsis care(82%),ventilator-associated pneumonia(79%);nutrition(76%),deep vein thrombosis prophylaxis(84%),stress ulcer prophylaxis(84%),and glycemic control(89%).CONCLUSION Based on the findings of this international,multi-dimensional,needs-assessment survey,there is a need for increased

关键词： Intensive care unit critical care Global Survey Intensive care unit survey Intensive care unit needs

Glucose control in critical care

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World Journal of Diabetes 2015年第9期6卷 1082-1091页

作者： Jeremy Clain Kannan Ramar Salim R Surani College of Medicine Division of Pulmonary and Critical Care Medicine Mayo Clinic Division of Pulmonary and critical care Medicine Mayo Clinic Division of Pulmonary Critical Care and Sleep Medicine Texas AM University

Glycemic control among critically-ill patients has been a topic of considerable attention for the past 15 years. An initial focus on the potentially deleterious effects of hyperglycemia led to a series of investigations regarding intensive insulin therapy strategies that targeted tight glycemic control. As knowledge accumulated, the pursuit of tight glycemic control among critically-ill patients came to be seen as counterproductive, and moderate glycemic control came to dominate as the standard practice in intensive care units. In recent years, there has been increased focus on the importance of hypoglycemic episodes, glycemic variability, and premorbid diabetic status as factors that contribute to outcomes among critically-ill patients. This review provides a survey of key studies on glucose control in critical care, and aims to deliver perspective regarding glycemic management among critically-ill patients.

关键词： Glycemic control critical care Blood sugar in intensive care unit Diabetes in intensive care unit