Current opinion in anaesthesiology
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Bystander cardiopulmonary resuscitation increases the chances of survival after out-of-hospital cardiac arrest. Existing bystander cardiopulmonary resuscitation rates are poor. There are several strategies for increasing the frequency and effectiveness of bystander cardiopulmonary resuscitation. These include simplifying the technique for basic life support, emphasizing the importance of compressions over ventilation, reducing the length of training by using video-based self-instruction and widening the range of those trained to include school children. ⋯ The optimal basic life support technique that will generate the highest survival rates from out-of-hospital cardiac arrest has not been determined, but there is increasing evidence that the existing technique needs to be simplified. Bystander cardiopulmonary resuscitation increases survival but it needs to be undertaken more frequently if overall survival rates are to be improved significantly.
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To assess the current role of selenium supplementation in critically ill patients. ⋯ Despite the low selenium content in the body (20-40 mg), selenoenzymes play an important role in antioxidant defense in humans. Selenium administration may be associated with improved outcomes, but further studies are needed to determine the precise mechanism of action. Studies are also needed to determine optimal dosing regimens, and to identify those patients in whom this approach is likely to be most effective. Currently, doses below the tolerable upper intake level (400 microg) may be used in supplementation. Higher doses (up to the level of no adverse effect, 800 microg) may be of interest and need to be studied further. The pro-oxidant effects of selenocompounds, especially sodium selenite, which vary depending on the compound, dose, and concentration, also need to be assessed further for their toxicity and potential therapeutic use in patients with septic shock.