Critical care : the official journal of the Critical Care Forum
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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.
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Status epilepticus (SE) has an annual incidence exceeding 100,000 cases in the United States alone, of which more than 20% result in death. Thus, increased awareness of presentation, etiologies, and treatment of SE is essential in the practice of critical care medicine. ⋯ An overview of the systemic pathophysiologic effects of SE is presented. Finally, significant studies on the treatment of acute SE and refractory SE are reviewed, including the use of anticonvulsants, such as benzodiazepines, and other drugs.
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Although mechanical ventilation is instituted as a life-saving technique, it may lead to complications that can negatively impact on patients' morbidity and/or mortality. Ventilator associated pneumonia (VAP) is one such complication that is a common challenge to intensivists. Although most experts would agree that early 'appropriate' antibiotic use is essential in patients who develop VAP, the best diagnostic test to guide decision-making is far from clear. ⋯ However, this procedure has associated costs and potential complications, and its utility in VAP has been challenged. In this issue of Critical Care Forum, the two sides of this debate are brought forward with compelling arguments. The authors' arguments should fuel future trials.
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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.