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Chest Nov 2018The digitalization of the health-care system has resulted in a deluge of clinical big data and has prompted the rapid growth of data science in medicine. Data science,... (Review)
Review
The digitalization of the health-care system has resulted in a deluge of clinical big data and has prompted the rapid growth of data science in medicine. Data science, which is the field of study dedicated to the principled extraction of knowledge from complex data, is particularly relevant in the critical care setting. The availability of large amounts of data in the ICU, the need for better evidence-based care, and the complexity of critical illness makes the use of data science techniques and data-driven research particularly appealing to intensivists. Despite the increasing number of studies and publications in the field, thus far there have been few examples of data science projects that have resulted in successful implementations of data-driven systems in the ICU. However, given the expected growth in the field, intensivists should be familiar with the opportunities and challenges of big data and data science. The present article reviews the definitions, types of algorithms, applications, challenges, and future of big data and data science in critical care.
Topics: Big Data; Critical Care; Data Science; Delivery of Health Care; Forecasting; Humans
PubMed: 29752973
DOI: 10.1016/j.chest.2018.04.037 -
Nephron. Clinical Practice 2012
Topics: Acute Kidney Injury; Critical Care; Humans; Nephrology; Quality Assurance, Health Care; United States
PubMed: 22890468
DOI: 10.1159/000339789 -
The Surgical Clinics of North America Feb 2022
Topics: COVID-19; Critical Care; Humans; Pandemics; Politics; Social Identification; United States
PubMed: 34800392
DOI: 10.1016/j.suc.2021.11.001 -
Critical Care (London, England) Sep 2021
Topics: Critical Care; Early Ambulation; Humans; Quality Improvement; Rehabilitation
PubMed: 34479621
DOI: 10.1186/s13054-021-03741-z -
Neurology India 2017Intensive care is a specialized branch of medicine dealing with the diagnosis, management, and follow up of critically ill or critically injured patients. It requires... (Review)
Review
Intensive care is a specialized branch of medicine dealing with the diagnosis, management, and follow up of critically ill or critically injured patients. It requires input from other branches of medicine on various issues. A critical care specialist has expertise in managing such patients round the clock. Based on his freedom to take decisions in the intensive care unit (ICU), different types of ICUs - open, closed, or semi-closed - have been defined. There is no doubt that all critical patients should be evaluated by an intensivist. Therefore, it is argued that a closed ICU model would be the ideal model. However, this may not always be feasible and other models may be more useful in resource-limited countries. In this review, we compare the different formats of ICU functioning and their suitability in different hospitals.
Topics: Critical Care; Humans; Intensive Care Units
PubMed: 28084236
DOI: 10.4103/0028-3886.198205 -
Infectious Disease Clinics of North... Sep 2017
Topics: Communicable Diseases; Critical Care; Humans; Infectious Disease Medicine
PubMed: 28779835
DOI: 10.1016/j.idc.2017.07.001 -
Critical Care Medicine Feb 2017Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new...
Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called "the postintensive care syndrome." Patients with postintensive care syndrome are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care. This article explains the science and philosophy of liberating ICU patients and families from harm that is both inherent to critical illness and iatrogenic. ICU liberation is an extensive program designed to facilitate the implementation of the pain, agitation, and delirium guidelines using the evidence-based ABCDEF bundle. Participating ICU teams adapt data from hundreds of peer-reviewed studies to operationalize a systematic and reliable methodology that shifts ICU culture from the harmful inertia of sedation and restraints to an animated ICU filled with patients who are awake, cognitively engaged, and mobile with family members engaged as partners with the ICU team at the bedside. In doing so, patients are "liberated" from iatrogenic aspects of care that threaten his or her sense of self-worth and human dignity. The goal of this 2017 plenary lecture at the 47th Society of Critical Care Medicine Congress is to provide clinical ICU teams a synthesis of the literature that led to the creation of ICU liberation philosophy and to explain how this patient- and family-centered, quality improvement program is novel, generalizable, and practice changing.
Topics: Critical Care; Humans; Intensive Care Units; Patient Care Bundles; Personhood; Philosophy, Medical
PubMed: 28098628
DOI: 10.1097/CCM.0000000000002175 -
Intensive Care Medicine Mar 2012Acute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. The variety of definitions proposed in the past has led...
PURPOSE
Acute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. The variety of definitions proposed in the past has led to confusion and difficulty in comparing one study to another. An international working group convened to standardize the definitions for acute GI failure and GI symptoms and to review the therapeutic options.
METHODS
The Working Group on Abdominal Problems (WGAP) of the European Society of Intensive Care Medicine (ESICM) developed the definitions for GI dysfunction in intensive care patients on the basis of the available evidence and current understanding of the pathophysiology.
RESULTS
Definitions for acute gastrointestinal injury (AGI) with its four grades of severity, as well as for feeding intolerance syndrome and GI symptoms (e.g. vomiting, diarrhoea, paralysis, high gastric residual volumes) are proposed. AGI is a malfunctioning of the GI tract in intensive care patients due to their acute illness. AGI grade I = increased risk of developing GI dysfunction or failure (a self-limiting condition); AGI grade II = GI dysfunction (a condition that requires interventions); AGI grade III = GI failure (GI function cannot be restored with interventions); AGI grade IV = dramatically manifesting GI failure (a condition that is immediately life-threatening). Current evidence and expert opinions regarding treatment of acute GI dysfunction are provided.
CONCLUSIONS
State-of-the-art definitions for GI dysfunction with gradation as well as management recommendations are proposed on the basis of current medical evidence and expert opinion. The WGAP recommends using these definitions for clinical and research purposes.
Topics: Critical Care; Critical Illness; Gastrointestinal Diseases; Gastrointestinal Tract; Humans; Severity of Illness Index; Terminology as Topic
PubMed: 22310869
DOI: 10.1007/s00134-011-2459-y -
Blood Purification 2019
Topics: Critical Care; Humans; Multiple Organ Failure; Sepsis
PubMed: 30974439
DOI: 10.1159/000499786 -
Revista Brasileira de Terapia Intensiva 2017Mobilization of critically ill patients admitted to intensive care units should be performed based on safety criteria. The aim of the present review was to establish... (Review)
Review
Mobilization of critically ill patients admitted to intensive care units should be performed based on safety criteria. The aim of the present review was to establish which safety criteria are most often used to start early mobilization for patients under mechanical ventilation admitted to intensive care units. Articles were searched in the PubMed, PEDro, LILACS, Cochrane and CINAHL databases; randomized and quasi-randomized clinical trials, cohort studies, comparative studies with or without simultaneous controls, case series with 10 or more consecutive cases and descriptive studies were included. The same was performed regarding prospective, retrospective or cross-sectional studies where safety criteria to start early mobilization should be described in the Methods section. Two reviewers independently selected potentially eligible studies according to the established inclusion criteria, extracted data and assessed the studies' methodological quality. Narrative description was employed in data analysis to summarize the characteristics and results of the included studies; safety criteria were categorized as follows: cardiovascular, respiratory, neurological, orthopedic and other. A total of 37 articles were considered eligible. Cardiovascular safety criteria exhibited the largest number of variables. However, respiratory safety criteria exhibited higher concordance among studies. There was greater divergence among the authors regarding neurological criteria. There is a need to reinforce the recognition of the safety criteria used to start early mobilization for critically ill patients; the parameters and variables found might contribute to inclusion into service routines so as to start, make progress and guide clinical practice.
Topics: Critical Care; Critical Illness; Early Ambulation; Humans; Intensive Care Units; Randomized Controlled Trials as Topic; Respiration, Artificial; Time Factors
PubMed: 29340541
DOI: 10.5935/0103-507X.20170076