Crit Care Resusc
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Randomized Controlled Trial
A double-blind placebo-controlled randomised pilot study of nocturnal melatonin in tracheostomised patients.
Patients in the intensive care unit often suffer from lack of sleep at night. We hypothesised that nocturnal melatonin may increase observed nocturnal sleep in tracheostomised patients. ⋯ Melatonin is well absorbed, and a standard dose increases blood levels approximately 1000-fold. However, in this pilot assessment, these high levels failed to increase observed nocturnal sleep or induce other observable benefits in tracheostomised ICU patients.
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Sepsis continues to be a major cause of morbidity and mortality. Evidence is emerging from observational studies and basic science research that statins (3-hydroxy, 3-methylglutaryl coenzyme A [HMG CoA] reductase inhibitors) might be associated with reduced mortality in sepsis. Statins have become the most widely used drugs for lowering serum cholesterol levels, being used by at least 15% of patients requiring admission to hospital, and this number is growing each year. ⋯ It suggests an urgent need to investigate the pharmacology of these drugs and reappraise their therapeutic indications in critically ill patients. This may provide new insights into the role of lipids and the endothelium in sepsis. Statins are significantly cheaper than other therapies that have been shown to improve outcome in sepsis, and the demonstration of a mortality benefit would have enormous cost-benefit implications.
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Randomized Controlled Trial
Comparison of normal or heparinised saline flushing on function of arterial lines.
Heparin is used as a flush solution for intravenous and intra-arterial lines, but has a number of drug interactions, as well as potentially serious side effects. ⋯ Heparin as a continuous flush at 3 units/hour does not improve the function of arterial lines compared with a continuous normal-saline flush.
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The use of intensive insulin therapy (IIT) to maintain blood glucose level below 8.3 mmol/L is recommended for management of severe sepsis by the Surviving Sepsis guidelines. The recent trials reporting reduced morbidity and mortality in critically ill patients treated with IIT require careful examination, including the subsequent post-hoc analyses. ⋯ Patients with severe sepsis are likely to benefit from IIT based on metabolic effects and their prolonged stays in the intensive care unit. The current evidence suggests IIT should be implemented, aiming for the lowest glycaemic range that can be safely achieved while avoiding hypoglycaemia.
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To measure functional outcome of long-stay intensive care unit patients in the Australian population. ⋯ Of 68 long-stay ICU patients, an average of 2 years after discharge, 50% were alive, including 25% living normal active lives. The remaining 25% described some disability. In most cases (88%), this was mild: only two patients (3% of the total group) depended on daily support. No patients were left in a persistent vegetative state.