242 research outputs found
Appendix_3_GLeblanc – Supplemental material for Incidence and impact of withdrawal of life-sustaining therapies in clinical trials of severe traumatic brain injury: A systematic review
No full textSupplemental material, Appendix_3_GLeblanc for Incidence and impact of withdrawal of
life-sustaining therapies in clinical trials of severe traumatic brain injury: A
systematic review by Guillaume Leblanc, Amélie Boutin, Michèle Shemilt, François Lauzier,
Lynne Moore, Véronique Potvin, Ryan Zarychanski, Patrick Archambault, François Lamontagne,
Caroline Léger and Alexis F Turgeon in Clinical Trials</p
Appendix_4_GLeblanc – Supplemental material for Incidence and impact of withdrawal of life-sustaining therapies in clinical trials of severe traumatic brain injury: A systematic review
No full textSupplemental material, Appendix_4_GLeblanc for Incidence and impact of withdrawal of
life-sustaining therapies in clinical trials of severe traumatic brain injury: A
systematic review by Guillaume Leblanc, Amélie Boutin, Michèle Shemilt, François Lauzier,
Lynne Moore, Véronique Potvin, Ryan Zarychanski, Patrick Archambault, François Lamontagne,
Caroline Léger and Alexis F Turgeon in Clinical Trials</p
Appendix_2_GLeblanc – Supplemental material for Incidence and impact of withdrawal of life-sustaining therapies in clinical trials of severe traumatic brain injury: A systematic review
No full textSupplemental material, Appendix_2_GLeblanc for Incidence and impact of withdrawal of
life-sustaining therapies in clinical trials of severe traumatic brain injury: A
systematic review by Guillaume Leblanc, Amélie Boutin, Michèle Shemilt, François Lauzier,
Lynne Moore, Véronique Potvin, Ryan Zarychanski, Patrick Archambault, François Lamontagne,
Caroline Léger and Alexis F Turgeon in Clinical Trials</p
10.1177_0269216314566060_supplementary_files – Supplemental material for Admission of the very elderly to the intensive care unit: Family members’ perspectives on clinical decision-making from a multicenter cohort study
No full textSupplemental material, 10.1177_0269216314566060_supplementary_files for Admission of the very elderly to the intensive care unit: Family members’ perspectives on clinical decision-making from a multicenter cohort study by Daren K Heyland, Peter Dodek, Sangeeta Mehta, Deborah Cook, Allan Garland, Henry T Stelfox, Sean M Bagshaw, Demetrios J Kutsogiannis, Karen Burns, John Muscedere, Alexis F Turgeon, Rob Fowler, Xuran Jiang and Andrew G Day in Palliative Medicine</p
Design Features of Explicit Values Clarification Methods: A Systematic Review
No full textAnalysis and support of clinical decision makin
Effects of design features of explicit values clarification methods: A systematic review
No full textAnalysis and support of clinical decision makin
Hemoglobin Area and Time Index Above 90 g/L are Associated with Improved 6-Month Functional Outcomes in Patients with Severe Traumatic Brain Injury
No full textPurpose: There is conflicting data on the relationship between anemia and outcomes in patients with traumatic brain injuries (TBI). The objective of this study was to determine if the proportion of time and area under the hemoglobin-time curve of ≥90 g/L are independently associated with 6-month functional outcomes. Methods: Retrospective cohort study of 116 patients with a severe TBI who underwent invasive neuromonitoring between June 2006 and December 2013. Hemoglobin area (HAI) and time (HTI) indices were calculated by dividing the total area, or time, under the hemoglobin-time curve at 90 g/L or above by the total duration of monitoring. Multivariable log-binomial regression was used to model the association between HAI or HTI and 6 month favorable neurologic outcome (Glasgow Outcome Score 4 or 5). Results: Patients had a mean age of 38 years (SD 16) with a median admission Glasgow Coma Scale of 6 (IQR 4–7). There were 1523 hemoglobin measurements and 523 monitoring days. Patients had a hemoglobin ≥90 g/L for a median of 70 % (IQR 37–100) of the time. Each 10 g/L increase in HAI (RR 1.23, 95 %CI 1.04–1.44, P = 0.011), and 10 % increase in HTI (1.10, 95 %CI 1.04–1.16, P < 0.001) were associated with improved neurologic outcome. Thirty-one patients (27 %) received a transfusion with the median pre-transfusion hemoglobin being 81 g/L (IQR 76–87). Conclusions: In patients with severe TBI, increased area under the curve and percentage of time that the hemoglobin concentration was ≥90 g/L, were associated with improved neurologic outcomes
Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study
No full textBACKGROUND: Severe traumatic brain injury often leads to death from withdrawal of life-sustaining therapy, although prognosis is difficult to determine.METHODS: To evaluate variation in mortality following the withdrawal of life-sustaining therapy and hospital mortality in patients with critical illness and severe traumatic brain injury, we conducted a two-year multicentre retrospective cohort study in six Canadian level-one trauma centres. The effect of centre on hospital mortality and withdrawal of life-sustaining therapy was evaluated using multivariable logistic regression adjusted for baseline patient-level covariates (sex, age, pupillary reactivity and score on the Glasgow coma scale).RESULTS: We randomly selected 720 patients with traumatic brain injury for our study. The overall hospital mortality among these patients was 228/720 (31.7%, 95% confidence interval [CI] 28.4%-35.2%) and ranged from 10.8% to 44.2% across centres (χ(2) test for overall difference, p < 0.001). Most deaths (70.2% [160/228], 95% CI 63.9%-75.7%) were associated with withdrawal of life-sustaining therapy, ranging from 45.0% (18/40) to 86.8% (46/53) (χ(2) test for overall difference, p < 0.001) across centres. Adjusted odd ratios (ORs) for the effect of centre on hospital mortality ranged from 0.61 to 1.55 (p < 0.001). The incidence of withdrawal of life-sustaining therapy varied by centre, with ORs ranging from 0.42 to 2.40 (p = 0.001). About one half of deaths that occurred following the withdrawal of life-sustaining therapies happened within the first three days of care.INTERPRETATION: We observed significant variation in mortality across centres. This may be explained in part by regional variations in physician, family or community approaches to the withdrawal of life-sustaining therapy. Considering the high proportion of early deaths associated with the withdrawal of life-sustaining therapy and the limited accuracy of current prognostic indicators, caution should be used regarding early withdrawal of life-sustaining therapy following severe traumatic brain injury.</p
Ten false beliefs in neurocritical care.
No full textIn acute brain injury, the need for specific expertise on central nervous pathophysiology is evident. However, even when the primary reason for ICU admission is extracranial, the brain may be affected too, through inadequate substrate and oxygen delivery, blood brain barrier leek, harmful effects of sedatives, and excitotoxicity. The resulting spectrum of brain dysfunction includes delirium, encephalopathy, coma, and non-convulsive seizures. Therefore, all intensive care should integrate neuro-intensive care, with the primary goal to preserve the brain
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