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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Haemodynamic instability and respiratory failure are common in critically ill patients, with sepsis being a frequent cause. Echocardiography is a useful, practical and safe bedside tool for diagnosis and management of these problems. ⋯ Its use can help determine whether, and when, continuous haemodynamic monitoring should be instituted. It is the best monitor for the management of sepsis because of its broad clinical utility and as a reference for the judicious use of invasive monitoring.
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Comment Letter Biography Historical Article
History of mouth-to-mouth rescue breathing: some matters concerning John and Anthony Fothergill.
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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.