Crit Care Resusc
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To develop an outcome measure as a basis for prescribing and evaluating rehabilitation in the critically ill, and to measure its reliability and responsiveness to change. The study also aimed to assess the feasibility and safety of a pilot exercise training protocol in an intensive care unit. ⋯ The PFIT is a reliable and responsive outcome measure, and the pilot training protocol was safe and feasible. As exercise may attenuate weakness and functional impairment, the PFIT can be used to prescribe and evaluate exercise and mobilisation. Future research should aim to develop a PFIT score and investigate the ability of the PFIT to predict ICU readmission risk and functional outcome.
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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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Despite government encouragement for patients to make advance plans for medical treatment, and the increasing numbers of patients who have done this, there is little research that examines how doctors regard these plans. ⋯ Many intensive care doctors believe end-oflife decisions remain medical decisions, and MEPAs and ACPs need only be respected when they accord with the doctor's treatment decision. This study suggests a need for further education of doctors, particularly those working in intensive care, who are responsible for initiating and maintaining life support treatment.
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To evaluate outcomes of patients admitted to an intensive care unit with idiopathic pulmonary fibrosis (IPF) and acute respiratory deterioration. ⋯ Outcomes of patients with IPF admitted to the ICU are poor. Indications for mechanical ventilation appear uncertain.
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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.