Critical care : the official journal of the Critical Care Forum
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Editorial Comment
Number needed to treat = six: therapeutic hypothermia following cardiac arrest--an effective and cheap approach to save lives.
In 2005, the European Resuscitation Council (ERC) guidelines stated: Unconscious adult patients with spontaneous circulation after out-of-hospital ventricular fibrillation cardiac arrest should be cooled to 32 to 34 degrees C for 12 to 24 hours. Patients with cardiac arrest from a non-shockable rhythm, in-hospital patients and children may also benefit from hypothermia. There is no argument to wait. We have to treat the next unconscious cardiac arrest patient with hypothermia.
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Editorial Comment
Corticosteroids to prevent postextubation upper airway obstruction: the evidence mounts.
Intubation of the airway can lead to laryngotracheal injury, resulting in extubation failure from upper airway obstruction (UAO). A number of factors can help to identify patients who are at greatest risk for postextubation UAO. Three randomized controlled trials demonstrate that prophylactic corticosteroids decrease the risk for postextubation UAO and probably the need for re-intubation.
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Editorial Comment
Perioperative goal directed haemodynamic therapy--do it, bin it, or finally investigate it properly?
The literature concerning the use of goal directed haemodynamic therapy (GDHT) in high risk surgical patients has been importantly increased by the study of Lopes and colleagues. Using a minimally invasive assessment of fluid status and pulse pressure variation monitoring during mechanical ventilation, improvements were seen in post-operative complications, duration of mechanical ventilation, and length of hospital and intensive care unit (ICU) stay. Many small studies have shown improved outcome using various GDHT techniques but widespread implementation has not occurred. Those caring for perioperative patients need to accept the published evidence base or undertake a larger, multi-centre study.
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A body of knowledge exists to suggest an association between nurse staffing and adverse patient outcomes. Hugonnet and colleagues add further evidence by linking nurse staffing to late-onset ventilator-associated pneumonia. Discussed are a number of concerns surrounding the analytic component of this study, including the construction of variables and the statistical models. The authors' estimation that hospitals maintaining a nurse-to-patient ratio above 2.2 could decrease the risk of health care associated infections is based on findings that are potentially biased and unrealistic.
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Wireless communication and data transmission are playing an increasing role in the critical care environment. Early anecdotal reports of electromagnetic interference (EMI) with intensive care unit (ICU) equipment resulted in many institutions banning these devices. ⋯ Restrictions to the use of mobile devices are being lifted, and it has been suggested that the benefits of improved communication may outweigh the small risks. However, increased use of cellular phones and ever changing communication technologies require ongoing vigilance by healthcare device manufacturers, hospitals and device users, to prevent potentially hazardous events due to EMI.