Critical care : the official journal of the Critical Care Forum
-
One of the therapeutic essentials in severe sepsis and septic shock is an adequate fluid replacement to restore and maintain circulating plasma volume, improve organ perfusion and nutritive microcirculatory flow. The type of solution to be used as a fluid replacement remains under discussion. The aim of the study was to evaluate the effects of clinically used fluid replacement solutions on renal function and inflammatory response. ⋯ Despite similar maintenance of macrocirculation 6% hydroxyethylstarch 130/0.42 and Ringer's acetate significantly preserve renal function and attenuate tubular damage better than 10% hydroxyethylstarch 200/0.5 in saline.
-
Airway management during cardiac arrests is a controversial area. There are advantages to the provision of a patent airway with an airway adjunct, especially as this can optimize oxygenation and carbon dioxide clearance as well as facilitate continuous compressions. These advantages come at a potential cost, in particular errors in placement of the devices and interruption to compressions necessitated for insertion. ⋯ In the previous issue of Critical Care, a study from Japan reported the use of advanced airways in more than 5,000 victims of cardiac arrests. The authors were not able to demonstrate a survival advantage with either SGAs or endotracheal intubation (ETI). They did, however, demonstrate improved outcomes when the emergency life-saving technicians had been trained to perform ETI and when the advanced airway device was inserted earlier.