Crit Care Resusc
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Clinical Trial
Implementation and outcomes of a severe sepsis protocol in an Australian tertiary hospital.
To evaluate the effect of implementation of a sepsis protocol. ⋯ Implementation of a sepsis protocol led to a change in the delivery of care with no reduction in mortality in patients with severe sepsis and septic shock admitted to a Level III ICU in a tertiary hospital.
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There is evidence that intensive glycaemic control decreases morbidity and mortality in surgical intensive care unit patients. In traumatic brain injury, hyperglycaemia is a prognostic indicator. ⋯ The intensive insulin protocol was effective in lowering blood glucose in neurosurgical ICU patients.
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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.