Critical care : the official journal of the Critical Care Forum
-
The present review introduces the commonly used t-test, used to compare a single mean with a hypothesized value, two means arising from paired data, or two means arising from unpaired data. The assumptions underlying these tests are also discussed.
-
The review by Oliveira and colleagues on the subject of hypertonic saline resuscitation in sepsis (included in the present issue) suggests possible benefits for hypertonic saline. There is a firm experimental basis for the actions of hypertonic saline/hyperoncotic solutions in hemorrhagic hypotension, which include expansion of blood volume, improvement in cardiac index, favorable modulation of the immune system, and improvement in survival. ⋯ The major impact of early administration of hypertonic solutions may be attenuation of tissue injury, sepsis, and septic shock. Early and aggressive fluid resuscitation with hypertonic solutions to clinical end-points should be investigated in patients with systemic inflammatory response syndrome, sepsis, and septic shock.
-
Problems with commissioning paediatric intensive care stem both from difficulties in recruitment and retention of nurses, and from incoherent or nonexistent national audit. Pyramidal career structures and patterns of remuneration that concentrate on administrative responsibility over clinical skills underlie the former, whereas poor audit conceals variations in both service quality and demand. Epidemiologically superior data are required if we are to solve commissioning problems. We need to know what happened to every child from a defined population receiving intensive care and whether a lack of resources means that some children are denied intensive care.
-
Corticosteroid treatment of severe sepsis has been one of the most controversial clinical issues in critical care. In fact, few agents can claim to have been evaluated in scores of studies spanning 3-4 decades. ⋯ Recently, interest has resurfaced but this time the focus is on a steroid replacement approach for what has now been termed "relative adrenal insufficiency" rather than relying on the pharmacologic effects of steroids. This route holds promise, but proof remains lacking.
-
Hypothermia as a protectant of neurologic function in the treatment of cardiac arrest patients, although not a new concept, is now supported by two recent randomized, prospective clinical trials. The basic science research in support of the effects of hypothermia at the cellular and animal levels is extensive. The process of cooling for cerebral protection holds potential promise for human resuscitation efforts in multiple realms. It appears that, at least, those patients who suffer a witnessed cardiac arrest with ventricular fibrillation and early restoration of spontaneous circulation, such as those who were included in the European and Australian trials (discussed here), should be considered for hypothermic therapy.