Critical care : the official journal of the Critical Care Forum
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Cardiovascular failure is the leading cause of death in severe acute drug intoxication. In this setting, we report the feasibility, complications, and outcome of emergency extracorporeal life support (ECLS) in refractory shock or cardiac arrest following a drug overdose. ⋯ Based on our experience, we consider ECLS as a last resort, efficient, and relatively safe therapeutic option in this population. However, the uncontrolled nature of our data requires careful interpretation.
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Severe tissue trauma results in a general inflammatory immune response (SIRS) representing an overall inflammatory reaction of the immune system. However, there is little known about the functional alterations of monocytes in the early posttraumatic phase, characterized by the battle of the individual with the initial trauma. ⋯ As our data derived from very narrow intervals of measurements, they might contribute to a more detailed understanding of the early immune alterations recognized after severe trauma. It can be concluded that indeed as previously postulated an immediate hyperactivation of circulating monocytes is rapidly followed by a substantial paralysis of cell function. Moreover, our findings clearly demonstrate that the restricted capacity of monocytes to produce proinflammatory cytokines after severe injury is not only an in vitro phenomenon but also undistinguishable associated with the onset of organ dysfunction in the clinical scenario.
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Volumetric parameters acquired by transpulmonary thermodilution had been repeatedly proven superior to filling pressures for estimation of cardiac preload. Up to now, the proposed normal ranges were never studied in detail. We investigated the relationship of the global end-diastolic volume (GEDV) acquired by transpulmonary thermodilution with age and gender in awake and spontaneously breathing patients. ⋯ The volumetric parameter GEDV shows a large inter-individual variance and is dependent on age and gender. These dependencies persist after indexing GEDV to body surface area calculated with predicted body weight. Targeting resuscitation using fixed ranges of preload volumes acquired by transpulmonary thermodilution without concern to an individual patient's age and gender seems not to be appropriate.
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ICU delirium is associated with poor patient outcome. Risk factor stratification is essential to the understanding, prevention and treatment of this disorder. Alcohol consumption, smoking and prior cognitive impairment appear strongly correlated with delirium risk. Several potentially modifiable associations deserve prospective study: these include administration of sedatives and opiates; multiple catheters; as well as minimizing physical restraints and enabling visitors.
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The usefulness of basic cardiopulmonary resuscitation (CPR) training in school systems has been questioned, considering that young students may not have the physical or cognitive skills required to perform complex tasks correctly. In the study conducted by Fleishhackl and coworkers, students as young as 9 years were able to successfully and effectively learn basic CPR skills, including automated external defibrillator deployment, correct recovery position, and emergency calling. As in adults, physical strength may limit the depth of chest compressions and ventilation volumes given by younger individuals with low body mass index; however, skill retention is good. ⋯ Training captured audiences of trainees, such as the entire work-force of the community or the local school system, are excellent mechanisms to help achieve that goal. In addition to better retention with new half hour training kits, a multiplier effect can be achieved through school children. In addition, early training not only sets the stage for subsequent training and better retention, but it also reinforces the concept of a social obligation to help others.