Critical care medicine
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Critical care medicine · Nov 2012
Review Meta AnalysisEfficacy spectrum of antishivering medications: meta-analysis of randomized controlled trials.
Shivering after anesthesia or in the critical care setting is frequent, can be prolonged, and has the potential for serious adverse events and worsening outcomes. Furthermore, there are conflicting published data and clinical protocols on how to best treat shivering. In this study, we aimed to critically analyze the published evidence of antishivering medications. ⋯ There is significant heterogeneity in the literature with respect to study methods and efficacy testing of antishivering treatments. Clonidine, meperidine, tramadol, nefopam, and ketamine were the most frequently reported pharmacological interventions and showed a variable degree of efficacy in randomized, double-blinded, placebo-controlled trials.
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Critical care medicine · Nov 2012
Review Meta AnalysisEtomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis*.
To evaluate the effects of single-dose etomidate on the adrenal axis and mortality in patients with severe sepsis and septic shock. ⋯ Administration of etomidate for rapid sequence intubation is associated with higher rates of adrenal insufficiency and mortality in patients with sepsis.
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Critical care medicine · Nov 2012
Association of cystic fibrosis transmembrane conductance regulator gene variants with acute lung injury in African American children with pneumonia*.
The cystic fibrosis transmembrane conductance regulator regulates fluid balance in alveolar epithelial cells and appears to modulate the inflammatory response. To determine whether more severe lung injury in children who develop community-acquired pneumonia is associated with variations known to affect function in the gene coding for cystic fibrosis transmembrane conductance regulator. ⋯ Genetic variation in cystic fibrosis transmembrane conductance regulator is associated with acute lung injury in African American children with community-acquired pneumonia.
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Critical care medicine · Nov 2012
Mild hypothermia decreases arrhythmia susceptibility in a canine model of global myocardial ischemia*.
Although the majority of sudden cardiac arrests occur in patients with ischemic heart disease, the effect of therapeutic hypothermia on arrhythmia susceptibility during acute global ischemia is not well understood. While both ischemia and severe hypothermia are arrhythmogenic, patients undergoing therapeutic hypothermia do not have an increase in arrhythmias, despite the fact that most sudden cardiac arrest occur in the setting of ischemia. We hypothesized that mild hypothermia induced prior to myocardial ischemia and reperfusion will have a beneficial effect on ischemia-related arrhythmia substrates. ⋯ Mild hypothermia attenuated ischemia-induced increase in dispersion of repolarization, conduction slowing, and block, which are known mechanisms of arrhythmogenesis in ischemia. These data suggest that therapeutic hypothermia may decrease arrhythmogenesis during myocardial ischemia.
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To review the current status of critical care education of medical students, focusing on how early, vigorous undergraduate training may address the needs of the learners and society. ⋯ Undergraduate medical education in critical care would be advanced by consolidation and organization into formal curricula. These would teach biomedical and humanistic skills essential to critical care but valuable in all medical settings. Early, well-planned exposure to critical care as a distinct discipline might increase student interest in careers in the field. The effects of educational interventions on the acquisition of knowledge, attitudes, and skills as well as long-term career choice should be subjected to rigorous study.