Enhancing Diagnosis Through Technology
Patient care in intensive care environments is complex, time-sensitive, and data-rich, factors that make these settings particularly well-suited to clinical decision support (CDS). A wide range of CDS interventions have been used in intensive care unit environments. The field needs well-designed studies to identify the most effective CDS approaches. Evolving artificial intelligence and machine learning models may reduce information-overload and enable teams to take better advantage of the large volume of patient data available to them. It is vital to effectively integrate new CDS into clinical workflows and to align closel...
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Robert El-Kareh, Dean F. Sittig Source Type: research

Enhancing Analytical Reasoning in the Intensive Care Unit
Clinical reasoning is prone to errors in judgment. Error is comprised of 2 components —bias and noise; each has an equally important role in the promulgation of error. Biases or systematic errors in reasoning are the product of misconceptions of probability and statistics. Biases arise because clinicians frequently rely on mental shortcuts or heuristics to make judgments. The most frequently used heuristics are representativeness, availability, and anchoring/adjustment which lead to the common biases of base rate neglect, misconceptions of regression, insensitivities to sample size, and fallacies of conjunctive, and disj...
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Mark Barash, Rahul S. Nanchal Source Type: research

Diagnostic Stewardship
Diagnostic stewardship encompasses the entire diagnosis-to-treatment paradigm in the intensive care unit (ICU). Initially born of the antimicrobial stewardship movement, contemporary diagnostic stewardship aims to promote timely and appropriate diagnostic testing that directly links to management decisions. In the stewardship framework, excessive diagnostic testing in low probability cases is discouraged due to its tendency to generate false-positive results, which have their own downstream consequences. Though the evidence basis for diagnostic stewardship initiatives in the ICU is nascent and largely limited to retrospect...
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Yasaman Fatemi, Paul A. Bergl Source Type: research

Learning from Missed Opportunities Through Reflective Practice
Identification of diagnostic errors is difficult but is not alone sufficient for performance improvement. Instead, cases must be reflected on to identify ways to improve decision-making in the future. There are many tools and modalities to retrospectively reflect on action to study medical decisions and outcomes and improve future performance. Reflection in action —in which diagnostic decisions are considered in real-time—may also improve medical decision-making especially through strategies such as structured reflection. Ongoing regular feedback can normalize the discussion about improving decision-making, enable refl...
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Gopi J. Astik, Andrew P.J. Olson Source Type: research

The Quest for Diagnostic Excellence in Critical Care
The modern intensive care unit (ICU) abounds with complexity. We support multiple failing organ systems, often among patients with a bewildering array of comorbidities and complications. We deal with the challenging tripartite intersection of what is possible, what patients and families desire, and what is reasonable. To stabilize deranged physiology, we apply an armamentarium of sophisticated technologies that in turn generate patient data ad infinitum: vital signs, laboratory test results, diagnostic images, ventilator parameters, measures of cardiac output, fluid balances, and much more. (Source: Critical Care Clinics)
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Paul A. Bergl, Rahul S. Nanchal Tags: Preface Source Type: research

Diagnostic Error in the Critically Ill
Epidemiologic studies of diagnostic error in the intensive care unit (ICU) consist mostly of descriptive autopsy series. In these studies, rates of diagnostic errors are approximately 5% to 10%. Recently validated methods for retrospectively measuring error have expanded our understanding of the scope of the problem. These alternative measurement strategies have yielded similar estimates for the frequency of diagnostic error in the ICU. Although there is a fair understanding of the frequency of errors, further research is needed to better define the risk factors for diagnostic error in the ICU. (Source: Critical Care Clinics)
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Paul A. Bergl, Yan Zhou Source Type: research

Diagnostic Excellence in the ICU: Thinking Critically and Masterfully
CRITICAL CARE CLINICS (Source: Critical Care Clinics)
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Authors: Paul A. Bergl, Rahul S. Nanchal Source Type: research

Copyright
ELSEVIER (Source: Critical Care Clinics)
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Source Type: research

Contributors
GREGORY S. MARTIN, MD, MSC (Source: Critical Care Clinics)
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Source Type: research

Contents
Paul A. Bergl and Rahul S. Nanchal (Source: Critical Care Clinics)
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Source Type: research

Forthcoming Issues
Undiagnosed and Rare Diseases in Critical Care (Source: Critical Care Clinics)
Source: Critical Care Clinics - November 16, 2021 Category: Intensive Care Source Type: research

The Epidemiology of Acute Respiratory Distress Syndrome Before and After Coronavirus Disease 2019
Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome of high morbidity and mortality with global impact. Current epidemiologic estimates are imprecise given differences in patient populations, risk factors, resources, and practice styles around the world. Despite improvement in supportive care which has improved mortality, effective targeted therapies remain elusive. The Coronavirus Disease 2019 pandemic has resulted in a large number of ARDS cases that, despite less heterogeneity than multietiologic ARDS populations, still exhibit wide variation in physiology and outcomes. Intensive care unit rates of de...
Source: Critical Care Clinics - September 19, 2021 Category: Intensive Care Authors: Kathryn W. Hendrickson, Ithan D. Peltan, Samuel M. Brown Source Type: research

Environmental Factors
The acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in the intensive care unit. Improving outcomes depends on not only evidence-based care once ARDS has already developed but also preventing ARDS incidence. Several environmental exposures have now been shown to increase the risk of ARDS and related adverse outcomes. How environmental factors impact the risk of developing ARDS is a growing and important field of research that should inform the care of individual patients as well as public health policy. (Source: Critical Care Clinics)
Source: Critical Care Clinics - September 19, 2021 Category: Intensive Care Authors: Katherine D. Wick, Michael A. Matthay Source Type: research

Genetics of Acute Respiratory Distress Syndrome
This article discusses the latest advances in ARDS genomics, provides historical perspective, and highlights some of the ways that the coronavirus disease 2019 (COVID-19) pandemic is accelerating genomic ARDS research. (Source: Critical Care Clinics)
Source: Critical Care Clinics - September 19, 2021 Category: Intensive Care Authors: Heather M. Giannini, Nuala J. Meyer Source Type: research

Pharmacologic Treatments for Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome is a heterogenous syndrome with many etiologies for which there are no definitive pharmacologic treatments, despite decades of research. We explore some adjunctive pharmacologic therapies, including neuromuscular blockade, corticosteroids, and inhaled pulmonary vasodilators. Additionally, we explore some investigative therapies, including Vitamin C, beta-agonists, statins, mesenchymal stromal cells, and granulocyte –macrophage colony stimulating factor. We do discuss the potential role of steroids in acute respiratory distress syndrome with severe acute respiratory syndrome coronavirus...
Source: Critical Care Clinics - September 19, 2021 Category: Intensive Care Authors: Nida Qadir, Steven Y. Chang Source Type: research