Journal of critical care
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Journal of critical care · Mar 2009
ReviewClinical limitations of acetylcholinesterase antagonists.
Administration of a nondepolarizing neuromuscular blocking drug (muscle relaxant) is a standard practice in many anesthetic scenarios. These muscle relaxants work by competitive antagonism of the neurotransmitter acetylcholine at nicotinic cholinergic receptors within the neuromuscular junction of skeletal muscle (Martyn et al; Neuromuscular physiology and pharmacology, anesthesia. Edited by RD Miller, Philadelphia, Churchill Livingstone, 2000). ⋯ Pharmacologic reversal currently relies on the administration of an anticholinesterase drug, which decreases the metabolism of acetylcholine at the neuromuscular junction and allows its concentration to increase and hopefully overcome the effect of the muscle relaxant. This approach to reversal has significant limitations; the mechanism of reversal is indirect, the efficacy is limited and unpredictable, and undesirable autonomic responses occur. This review will address these limitations.
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Journal of critical care · Mar 2009
The effect of comorbidities on risk of intensive care readmission during the same hospitalization: a linked data cohort study.
The aim of this study is to assess the effect of comorbidities on risk of readmission to an intensive care unit (ICU) and the excess hospital mortality associated with ICU readmissions. ⋯ Comorbidity was a risk factor for late ICU readmission. Comorbidities could not account for the excess mortality associated with ICU readmissions.
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Since the introduction of nondepolarizing neuromuscular blocking agents, acetylcholinesterase inhibitors have been used to increase the speed of recovery from neuromuscular blockade. The major disadvantages of acetylcholinesterase inhibitors are their lack of activity against profound neuromuscular blockade and their activity outside the neuromuscular junction resulting in unwanted side effects, requiring cotreatment with a muscarinic antagonist. An alternative to acetylcholinesterase inhibitors is the encapsulating agent sugammadex. ⋯ Sugammadex is also effective against neuromuscular blockade under conditions with reduced acetylcholine release, which potentiate the action of neuromuscular blocking agents. Sugammadex does not cause cholinergic side effects, preventing the need of coadministration of muscarinic antagonists. Because of these properties, sugammadex has the potential to become a very useful drug for the management of neuromuscular blockade.
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Journal of critical care · Mar 2009
Observational study of patient-ventilator asynchrony and relationship to sedation level.
Clinicians frequently administer sedation to facilitate mechanical ventilation. The purpose of this study was to examine the relationship between sedation level and patient-ventilator asynchrony. ⋯ Asynchrony is common, and deeper sedation level is a predictor of ineffective triggering.
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Journal of critical care · Mar 2009
Location of patients before transfer to a tertiary care intensive care unit: impact on outcome.
To evaluate the impact of the source of patients transferred to a tertiary care intensive care unit (ICU) (referring hospital ICU vs referring hospital emergency department [ED]) on outcomes of transferred patients. ⋯ Transfer of patients to a tertiary care ICU from the ED of a referring hospital is associated with significantly better outcomes than transfers from referring hospital ICUs.