Critical care : the official journal of the Critical Care Forum
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The purpose of this study is to assess the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Mortality Probability Model MPM II0 and MPM II24 systems in a major tertiary care hospital in Riyadh, Saudi Arabia. ⋯ In our ICU population: 1) Overall mortality prediction, estimated by standardized mortality ratio, was accurate, especially for MPM II0 and APACHE II. 2) MPM II24 has the best calibration. 3) SAPS II has the lowest calibration and discrimination. The local performance of MPM II24 in addition to its ease-to-use makes it an attractive model for mortality prediction in Saudi Arabia.
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Acetaminophen toxicity, which can lead to hepatotoxicity, is a burden on our health care system and contributes significantly to intensive care unit admissions and cost of hospitalization. The aim of our study was to determine the epidemiology of various types of acetaminophen poisoning and analyze their outcome compared with their admission characteristics. ⋯ We recommend that the patients with suicidal acetaminophen overdose, without any concomitant poisoning, can safely managed on the medical floors.
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Review
Pro/con clinical debate: are steroids useful in the management of patients with septic shock?
Decision-making in the intensive care unit is often very difficult. Although we are encouraged to make evidence-based decisions, this may be difficult for a number of reasons. To begin with, evidence may not exist to answer the clinical question. ⋯ Finally, emotions are often highly charged when caring for patients that have a significant chance of death, and care-givers as well as families are frequently prepared to take chances on a therapy whose benefit is not entirely clear. Steroid use in septic shock is an example of a therapy that makes some sense but has conflicting support in the literature. In this issue of Critical Care Forum, the two sides of this often heated debate are brought to the forefront in an interesting format.
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Over the past 12 years there have been 12 randomised control trials, involving 843 infants, evaluating the effect of salbutamol or albuterol on bronchiolitis. Of these, nine (75%) showed that bronchodilators had no effect. In three studies a small transient improvement in the acute clinical score was seen. ⋯ A significant improvement in pulmonary resistance was observed after nebulised adrenaline but not after salbutamol or albuterol. Currently there is no compelling evidence that bronchodilators have a role in the routine management of infants with bronchiolitis. There is better evidence for the use of nebulised adrenaline.