Critical care : the official journal of the Critical Care Forum
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You have recently heard reports that synthetic colloids may be associated with renal failure and other morbidities in certain populations of critically ill patients. You have been asked by the hospital chief of staff whether there should be a suspension of the use of synthetic colloids until further information is available. You need to make a decision.
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Anemia is one of the most common medical complications to be encountered in critically ill patients. Based on the results of clinical trials, transfusion practices across the world have generally become more restrictive. However, because reduced oxygen delivery contributes to 'secondary' cerebral injury, anemia may not be as well tolerated among neurocritical care patients. ⋯ Although hemoglobin concentrations as low as 7 g/dl are well tolerated in most critical care patients, such a severe degree of anemia could be harmful in brain-injured patients. Randomized controlled trials of different transfusion thresholds, specifically in neurocritical care settings, are required. The impact of the duration of blood storage on the neurologic implications of transfusion also requires further investigation.
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Randomized Controlled Trial
Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study.
Critically ill patients are characterized by increased loss of muscle mass, partially attributed to sepsis and multiple organ failure, as well as immobilization. Recent studies have shown that electrical muscle stimulation (EMS) may be an alternative to active exercise in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients with myopathy. The aim of our study was to investigate the EMS effects on muscle mass preservation of critically ill patients with the use of ultrasonography (US). ⋯ EMS is well tolerated and seems to preserve the muscle mass of critically ill patients. The potential use of EMS as a preventive and rehabilitation tool in ICU patients with polyneuromyopathy needs to be further investigated.
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Multicenter Study
Off hour admission to an intensivist-led ICU is not associated with increased mortality.
Caring for the critically ill is a 24-hour-a-day responsibility, but not all resources and staff are available during off hours. We evaluated whether intensive care unit (ICU) admission during off hours affects hospital mortality. ⋯ The increased mortality after ICU admission during off hours is explained by a higher illness severity in patients admitted during off hours.
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Review
Monitoring trauma and intensive care unit resuscitation with tissue hemoglobin oxygen saturation.
The purpose of the present review is to review our experience with near-infrared spectroscopy (NIRS) monitoring in shock resuscitation and predicting clinical outcomes. ⋯ StO2 is an important tool in identifying high-risk patients in septic and hemorrhagic shock. It is a non-invasive means of obtaining vital information regarding outcome and adequacy of resuscitation.