Crit Care Resusc
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Serotonin toxicity secondary to drug therapy, interaction or overdose is an increasing phenomenon worldwide. A proportion of patients require admission to an intensive care unit, but the treatment needed is usually supportive and of short duration. Prolonged ICU admission to control ongoing or long-lasting serotonin toxicity has not been reported previously. ⋯ We review the pharmacological mechanisms that led to prolonged serotonin toxicity in these patients. Predictors for prolonged serotonin toxicity include involvement of irreversible monoamine oxidase inhibitors (MAOIs) or slow-release preparations resistant to the effects of activated charcoal (eg, lithium). We also discuss the implications of prolonged toxicity for critical care management, to maintain optimal patient outcomes.
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The role of glucocorticoid supplementation in septic shock remains contentious. In septic shock, the driver for steroid therapy is the premise that there is relative adrenal insufficiency (based on reduced plasma cortisol and blunted cortisol response to corticotropin). ⋯ Published evidence indicates that there are cellular adaptations in stress, such as pre-receptor upregulation of cortisol, altered receptor density and gene transcription changes, none of which are reflected by plasma cortisol level. This leads us to postulate that the lack of a clearly defined plasma response in severe stress and the presence of an adequate response at the cellular level suggest it is a "sick euadrenal state", analogous to the sick euthyroid state, and not a sick adrenal indicating adrenal insufficiency.
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Randomized Controlled Trial
Effects of saline or albumin resuscitation on standard coagulation tests.
To explore whether fluid resuscitation with normal saline or 4% albumin is associated with differential changes in routine clinical coagulation tests. ⋯ Administration of albumin or of larger fluid volumes is associated with a prolongation of APTT. In ICU patients, the choice and amount of resuscitation fluid may affect a routinely used coagulation test.
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Multicenter Study
Withholding and withdrawal of life-sustaining therapies in intensive care: an Australian experience.
Withholding and withdrawal of treatment in intensive care is currently widely accepted, but little has been published about Australian practice. ⋯ In this population of critically ill patients, most deaths occurred after discussion of end-of-life decisions and withholding or withdrawal of treatment.
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To evaluate the effect of the introduction of automated external defibrillators (AEDs) on survival after inhospital cardiac arrest. ⋯ ROSC and survival to hospital discharge did not change significantly after deployment of AEDs. The existence of a timely and robust resuscitation response with relatively good baseline outcomes, and the low proportion of initial shockable arrest rhythms may have limited the capacity of AEDs to improve survival.