Journal of critical care
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Journal of critical care · Feb 2016
Determination of death after circulatory arrest by intensive care physicians: A survey of current practice in the Netherlands.
Determination of death is an essential part of donation after circulatory death (DCD). We studied the current practices of determination of death after circulatory arrest by intensive care physicians in the Netherlands, the availability of guidelines, and the occurrence of the phenomenon of autoresuscitation. ⋯ Extensive variability in the practice of determining death after circulatory arrest exists, and a need for guidelines and standardization, especially if organ donation follows death, is reported. Autoresuscitation is reported; this observation requires attention in further prospective observational studies.
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Journal of critical care · Feb 2016
Prolonged postoperative respiratory support after proximal thoracic aortic surgery: Is deep hypothermic circulatory arrest a risk factor?
In addition to the pulmonary risks associated with cardiopulmonary bypass, thoracic aortic surgery using deep hypothermic circulatory arrest (DHCA) may subject the lungs to further injury. However, this topic has received little investigation to date. ⋯ Prolonged postoperative respiratory support is common after proximal aortic surgery. The use of DHCA was not associated with this complication in the overall cohort, although longer DHCA times were predictive when only the subset of patients undergoing DHCA was analyzed. Knowledge of the risk factors for PPRS after proximal aortic surgery should improve preoperative risk stratification and postoperative management of these patients.
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Journal of critical care · Feb 2016
Decreasing maintenance fluids in normotensive trauma patients may reduce intensive care unit stay and ventilator days.
The purpose of the study is to determine if excessive fluid administration is associated with a prolonged hospital course and worse outcomes. ⋯ A protocol that encourages admission basal fluid rate of TKO or 30 mL/h in normotensive trauma patients is safe, reduces fluid intake, and may be associated with a shorter intensive care unit course and fewer ventilator days.
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Severe sepsis continues to be a significant burden on society. ⋯ The incidence of severe sepsis continues to increase, whereas mortality decreases. However, one third of patients (those with ≥3 organ system failures) account for two thirds of the total number of deaths. More people are discharged home, whereas stable numbers go to facilities.