Crit Care Resusc
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Comparative Study
The outcome of patients with sepsis and septic shock presenting to emergency departments in Australia and New Zealand.
Early goal-directed therapy might benefit patients with sepsis and septic shock in Australia and New Zealand. However, the current treatment and outcome of these patients is unknown. ⋯ The reported incidence of sepsis and septic shock in ICU patients presenting to the ED appears to have increased since 1997. In contrast, hospital mortality has decreased. These data require confirmation with a prospective cohort study.
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Review Meta Analysis Comparative Study
Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis.
Loop diuretics are commonly used in critically ill patients with acute renal failure (ARF), but their effect on clinical outcome remains uncertain. We systematically reviewed the literature comparing loop diuretics with control in the management of ARF. ⋯ Loop diuretics were not associated with improved mortality or rate of independence from RRT, but were associated with shorter duration of RRT and increased urine output. However, these findings have limited relevance to critically ill patients. The relative paucity of high-quality data assessing the value of loop diuretics in ARF for the critically ill suggests a need for a suitably powered randomised trial.
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Comparative Study
Delirium in the intensive care unit: searching for causes and sources.
Currently, diagnosis of delirium in theintensive care unit requires the use of one of a range of screening scales. Publications on delirium in the ICU are increasing, but most focus on psychological markers, with only limited data on physiological indicators of delirium. ⋯ Treatment with CVVHDF was the only factor associated with the presence of delirium. Further research is warranted into physiological indicators as adjuncts to psychological assessment scales for delirium. The quest to find a simple biomarker for delirium continues.
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Comparative Study
C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a nested case-control study.
To assess the ability of potential clinical predictors and inflammatory markers to predict in-hospital mortality after patient discharge from the intensive care unit. ⋯ A high CRP concentration at ICU discharge is an independent predictor of subsequent in-hospital mortality. Prospective cohort studies in ICUs with different casemix, discharge criteria and post-ICU mortality rates are needed to validate and generalise our findings.
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Comparative Study Biography Historical Article
On the very first, successful, long-term, large-scale use of IPPV. Albert Bower and V Ray Bennett: Los Angeles, 1948-1949.
An "unprecedented respirator patient load at Los Angeles County Hospital [LACH] in 1948 (294 respirator cases)" arose from a seasonal increase in poliomyelitis cases to nearepidemic proportions. A finding by physician Albert Bower and his team that respiratory acidosis was frequent in patients receiving intermittent negative pressure ventilation (INPV), together with their awareness of a previous high mortality rate due to the standard treatment of polio ventilatory failure with Drinker-Collins respirators, led to multiple advances in equipment technology for LACH. Most important was biomedical engineer V Ray Bennett's positive pressure respirator attachment, in use after September 1948, which converted an INPV machine, the Drinker, into one capable of supplying "intratracheal" intermittent positive pressure ventilation (IPPV), supplementary to its NPV. ⋯ A complete system of respiratory care was developed for polio victims at LACH, setting levels of treatment and expertise distinctly higher, by 1950, than was current at other known polio respiration units, and preceding the well known developments in Copenhagen in the early 1950s. Extensive experience was obtained by a consistent medical staff, working as a team, in one hospital. Bower and Bennett deserve greater recognition of their pioneering merit than they currently receive in the written history of intensive care medicine.