Resuscitation
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Recognition of critically abnormal vital signs has been used to identify critically ill patients for activation of rapid response teams. Most studies have only analyzed vital signs obtained at the time of admission. The intent of this study was to examine the association of critical vital signs occurring at any time during the hospitalization with mortality. ⋯ The simultaneous presence of three critically abnormal vital signs can occur at any time during the hospital admission and is associated with very high mortality. Early recognition of these events presents an opportunity for decreasing mortality.
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The surfactant poloxamer 188 (P188) has been shown to improve survival following hemorrhage. This study used P188 as a small volume resuscitation product in a sedated, sexually mature, male miniature swine severe hemorrhage model for potential improvement in rate and time of survival. ⋯ In the presence of severe controlled hemorrhage, P188 improved median survival time. However, retardation of blood clotting raises concerns as to its use in the presence of uncontrolled hemorrhage.
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Recent investigations underscore the critical importance of ventilation strategies on resuscitation outcomes. In low perfusion states, such as cardiac arrest and traumatic shock, the rise in intrathoracic pressure that accompanies positive-pressure ventilation can significantly impede venous return and lead to a decrease in cardiac output. The optimal ventilation strategy in these "low-flow" states remains unclear. ⋯ A mathematical model of ventilation was successfully derived allowing manipulation of multiple pulmonary physiological variables to predict MITP and potentially identify optimal ventilation strategies. This model suggests the use of lower ventilation rates and larger tidal volumes to minimize the hemodynamic effects of positive pressure ventilation in patients with hypoperfusion but normal lung characteristics.
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Editorial Comment
Simulation provides a window on the quality and safety of the system.