Crit Care Resusc
-
Comparative Study
Attitudes of relatives of patients in intensive care and emergency departments to surrogate consent to research on incapacitated participants.
When potential research participants are incapable of providing consent, it is common for clinicians and researchers to approach family members, attempting to ascertain that person's wishes. Where legally recognised, surrogate consent may also then be provided by relatives for therapy or research involvement. This practice is widely accepted as acknowledging and maintaining patient autonomy, yet there are few data on acceptability of this to the community, or on the accuracy of surrogate decisions. ⋯ From our questionnaire, it appears that willingness to participate in research is less than we expected. Surrogate decision-making and the provision of surrogate consent to research was acceptable to only 26% of respondents.
-
Comparative Study
A technique for the simultaneous measurement of renal ATP, blood flow and pH in a large animal model of septic shock.
Simultaneous measurement of renal blood flow, renal ATP, renal pH and mean arterial pressure (MAP) might help investigators understand the mechanisms responsible for acute renal failure (ARF) in sepsis. ⋯ We have developed a technique to simultaneously monitor MAP, renal blood flow, ATP and pH in a large mammal during severe sepsis. Our initial observations indicate preservation of renal ATP in septic shock.
-
Sepsis is among the most common reasons for admission to intensive care units throughout the world. In 1991, a new set of terms and definitions was developed to define sepsis more precisely. The concept of the "systemic inflammatory response syndrome" (SIRS) was developed, and its diagnostic criteria were defined. ⋯ We suggest that septic shock is best defined by a systolic blood pressure less than 90 mmHg (or a fall in systolic blood pressure of > 40 mmHg), or a mean arterial pressure less than 65 mmHg after a crystalloid fluid challenge of 30 mL per kg body weight in a patient with severe sepsis. We believe that a vasopressor should be initiated in patients who remain hypotensive after this fluid challenge. The above operational definition of septic shock is important, as it clearly and unambiguously defines in which patients, and when, treatment with a vasopressor should be initiated, and in which patients adjunctive therapy with hydrocortisone and drotrecogin alfa (activated) should be considered.
-
Extracorporeal membrane oxygenation (ECMO) is a controversial means of life support, particularly in adults. Ongoing refinements in circuit technology and widening global experience have led to ECMO being applied to a broader group of conditions than acute respiratory failure and cardiogenic shock. Septicaemia is no longer viewed as a contraindication to ECMO. ⋯ The last indication is generally more applicable in children than adults, because of differences in the cardiovascular response to severe sepsis seen across age groups. ECMO has a role as rescue therapy in patients with severe sepsis who would otherwise die of either hypoxaemia or inadequate cardiac output. This review describes the basic technique and application of ECMO in neonates, older children, and adults with sepsis.