Critical care : the official journal of the Critical Care Forum
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Organ transplants continue to redefine medical frontiers. Unfortunately, current demand for organs far surpasses availability, waiting lists are long and many people die before the organ they desperately need becomes available. ⋯ If the injury is irretrievable, discussions would then focus on extending ventilation for potential brain death/organ donation if a prior wish to donate is known or if the substitute decision maker consents. The following debate discusses the ethical dilemmas of waiting for brain death.
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Sixty-three of 89 identified intensive care units in Colombia (Evaluation of Intensive Care in Colombia) participated in this voluntary study. A convenience sample of 20 intensive care units, each submitting 200 patients or more, was chosen, from which the following information is presented. The Intensive Care National Audit and Research Center (UK) protocol was used to evaluate patient severity, length of stay, raw and anticipated mortality, intensive care unit patient admission/rejection criteria, and human and technologic resources available. Information was drawn from public and private institutions.
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Hemofiltration may modulate the inflammatory response in sepsis through a variety of mechanisms. We sought to distinguish clearance from adsorption as the principal mechanism responsible for reducing circulating IL-6 levels with hemofiltration. ⋯ Hemofiltration-associated reductions in circulating IL-6 levels appear to be secondary to adsorption of mediators to the filter membrane. We do not know whether this is due to direct adsorption of IL-6 per se or to the absorption of other mediators with secondary downregulation of IL-6 production or release. In addition, we could not exclude an interaction between adsorption and hemofiltration.
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The present review introduces the commonly used t-test, used to compare a single mean with a hypothesized value, two means arising from paired data, or two means arising from unpaired data. The assumptions underlying these tests are also discussed.
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The review by Oliveira and colleagues on the subject of hypertonic saline resuscitation in sepsis (included in the present issue) suggests possible benefits for hypertonic saline. There is a firm experimental basis for the actions of hypertonic saline/hyperoncotic solutions in hemorrhagic hypotension, which include expansion of blood volume, improvement in cardiac index, favorable modulation of the immune system, and improvement in survival. ⋯ The major impact of early administration of hypertonic solutions may be attenuation of tissue injury, sepsis, and septic shock. Early and aggressive fluid resuscitation with hypertonic solutions to clinical end-points should be investigated in patients with systemic inflammatory response syndrome, sepsis, and septic shock.