Crit Care Resusc
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Comparative Study
Induced hypothermia after out-of-hospital cardiac arrest: one hospital's experience.
Induced mild hypothermia has been shown to reduce in-hospital mortality and to improve neurological outcome in patients who remain comatose after out-ofhospital cardiac arrest (OHCA). We conducted a retrospective audit to assess whether induced hypothermia had been successfully incorporated into routine care at our hospital, and whether this improved patient outcomes. ⋯ We found that induced hypothermia can be incorporated into routine care of patients admitted to an ICU after OHCA. For patients with an initial rhythm of VF or uVT, this seems to have significantly improved hospital survival and neurological outcome. We also found that rapid infusion of cold intravenous fluids was effective for inducing hypothermia.
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The Fellowship Examination for Intensive Care Medicine in Australian and New Zealand, first held in 1979, has undergone four distinct periods of development and change: * 1979-1996. Initiation and establishment of the exam as a relevant and comprehensive assessment process for a new specialty. * 1997-2001. (*) Revision to increase breadth of coverage and reliability for a growing number of candidates, and to ensure that each candidate received the same exam. (*) Expansion to incorporate assessment of CanMEDS skills, including communication, procedures and professional qualities. (*) Lengthening to increase the number of exposures, to ensure reliability. (*) Quarantining of candidates to allow the provision of a similar exam for each candidate. * 2002-2006. Increasing emphasis on examiner training and standard setting, increasing feedback to candidates to improve the educational experience and guide exam preparation, and blueprinting of questions to maintain validity. * 2007 onwards. ⋯ The exam has been regarded as a "tough but fair" assessment in its 30 years of existence, and the committee overseeing its development has aimed to continually review the process to maintain those qualities, as well as reliability, validity and feasibility. The increasing number of candidates has allowed usable statistics to be accumulated but has tested the feasibility of running such a labour-intensive exam. To date, there have been 800 presentations to the exam, with 498 successful candidates.
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Osmotically active solutions, particularly mannitol, havebeen used for more than 30 years in the treatment ofintracranial hypertension. Recently hypertonic saline hasemerged as an alternative to mannitol. ⋯ Here, we compare the systemic andcerebral effects of mannitol and hypertonic saline, as well astheir side effects and complications. Finally, we makerecommendations about their clinical use.
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Studies consistently show that nasogastric nutrition delivers only about 60% of nutritional goals in critically ill patients. The predominant reason is abnormal gastric motility, leading to delayed gastric emptying, which is evident clinically as large gastric residual volumes. Delayed gastric emptying occurs in about 50%-60% of critically ill patients who are fed enterally and can result in malnutrition. ⋯ Feed intolerance can be treated with prokinetic drugs and/or by the placement of postpyloric feeding catheters. The place of prokinetic agents in the treatment of feed intolerance is as yet unclear, but current evidence supports the administration of erythromycin combined with metoclopramide as first-line therapy. Other novel drugs, such as methylnaltrexone, mitemcinal, ghrelin agonists and dexloxiglumide, have potential advantages over these agents but require further investigation before widespread clinical use.