Resuscitation
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Comparative Study
Induction of profound hypothermia modulates the immune/inflammatory response in a swine model of lethal hemorrhage.
Profound hypothermic arrest ("suspended animation") is a new strategy to improve outcome following uncontrolled lethal hemorrhage (ULH). However, the impact of this approach on the immune/inflammatory response is unknown. This experiment was conducted to test the influence of profound hypothermia on markers of immune/inflammatory system. ⋯ Profound hypothermia modulates the post-shock immune/inflammatory system by attenuating the pro-inflammatory IL-6, increasing anti-inflammatory IL-10 and augmenting the protective heat shock responses.
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To study the concentration of oxygen flowing passively from the front and the rear parts of different brands of self-inflating bag valve mask ventilation devices at different oxygen flows and that flowing actively from the front part at different ventilation rates. ⋯ The Ambu device can provide 100% oxygen from its rear part even at low flow rates and 100% oxygen during active ventilation provided at least 10 L/min oxygen is used. The VBM is at a disadvantage when the oxygen source faces a hole; as the jet flowing in the bag causes a Venturi effect; which sucks air in from outside and dilutes the oxygen concentration provided. The ridge type does not have this problem. Ventilation at a rate of 30 min(-1) produced a higher oxygen concentration. The operator should be aware of the limitations of the device used.
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To report a patient with a large gastrointestinal stromal tumor (GIST) who received multiple blood transfusions intraoperatively and developed a transfusion-related acute lung injury (TRALI). ⋯ Rapid infusion of albumin might be a rescue option in cases of severe TRALI with extensive pulmonary capillary leak during the acute phase.
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Comparative Study
Reversible myocardial dysfunction after cardiopulmonary resuscitation.
Myocardial stunning frequently has been described in patients with an acute coronary syndrome. Recently, it has also been described in critically ill patients without ischaemic heart disease. It is possible that the most severe form of any syndrome, leading to cardio-respiratory arrest, may cause myocardial stunning. Myocardial stunning appears to have been demonstrated in experimental studies, though this phenomenon has not been sufficiently studied in human models. The aim of the present work has been to study and describe the possible development of myocardial dysfunction in patients resuscitated after cardio-respiratory arrest, in the absence of acute or previous coronary artery disease. ⋯ After successful CPR, reversible myocardial dysfunction, consisting of systolic myocardial dysfunction and disturbances of segmental contractility, may occur.
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Review Comparative Study
Are US informed consent requirements driving resuscitation research overseas?
Following a 2-year federally imposed moratorium on acute resuscitation research due to concern regarding the inability of patients in cardiac arrest to provide prospective, informed consent to participate in such research, the United States federal government in 1996 released regulations with provisions for exemption of prospective informed consent in certain types of emergency research. While very few acute resuscitation research studies have been attempted in the United States since that time, such research has continued overseas. ⋯ A recent European Union directive on the conduct of clinical trials may halt European research on patients who are unable to provide prospective, informed consent. The directive contains no provisions for exceptions or waiver of informed consent, and may hinder acute resuscitation research in Europe to an even greater degree than the 1996 regulations have in the United States.