Crit Care Resusc
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The scientific rationale for administering fresh frozen plasma (FFP) rests on the assumptions that patients are at risk of adverse effects from inadequate coagulation factors, and that FFP transfusions can decrease those risks. There is a general but unfounded enthusiasm for FFP use across a range of clinical specialties in hospital practice. Plasma for transfusion is most often used when a patient has abnormal results on coagulation screening tests, either as therapy in the face of bleeding, or in patients who are not bleeding as prophylaxis before invasive procedures or surgery. ⋯ It is also crucial to clearly understand the risks associated with use of FFP, as no studies have taken adequate account of the extent to which adverse effects might negate the clinical benefits of treatment with FFP. New trials are needed to evaluate the efficacy and adverse effects of plasma, both in bleeding and non-bleeding patients, and to determine whether presumed benefits outweigh the real risks. In addition, new haemostatic tests that better define the risk of bleeding and monitor the effectiveness of FFP use should be validated.
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Clinical Trial
Prospective observational study of levosimendan and weaning of difficult-to-wean ventilator dependent intensive care patients.
To evaluate the role of levosimendan in improving cardiac performance and the success rate of weaning from mechanical ventilation in ventilatordependent, difficult-to-wean patients with impaired cardiac function in the intensive care unit. ⋯ Levosimendan may provide significant benefit to ventilator-dependent patients with impaired left ventricular function. Randomised controlled trials appear justified.
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To improve the precision of currently available models for predicting length of stay of individual patients in the intensive care unit, to assist in directing patients into fast-track management after coronary artery bypass graft (CABG) surgery. ⋯ Although the optimal model greatly increases precision, it is still inadequate for scheduling fasttrack patients, where wrong predictions for individuals can cause major problems in resource allocation.
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Comparative Study Clinical Trial
Evaluation of a continuous glucose monitor in an unselected general intensive care population.
To assess the accuracy of the Guardian REALTime continuous glucose monitoring system (Medtronic MiniMed, Northridge, Calif, USA) in critically ill adults compared with standard bedside point-of-care testing of capillary and arterial blood glucose levels. ⋯ The Guardian REAL-Time continuous glucose monitoring system cannot replace current methods of blood glucose measurement at a glucose threshold of +/-1mmol/L. It may have role as an early warning detection system for hypo- or hyperglycaemia, but this needs to be evaluated in a prospective study of extremes of blood glucose levels in a critically ill population. Glucose measurements in arterial and capillary blood samples with a point-of-care glucometer also showed wide discrepancies.