Crit Care Resusc
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Critically ill patients are exposed to a combination of insults that affect both respiratory and peripheral skeletal muscle function. However, different muscle groups may not be affected to the same extent by a prolonged critical illness. ⋯ Currently available bedside methods of measuring respiratory and peripheral muscle function in critically ill patients are somewhat inadequate. Yet there is evidence suggesting that respiratory muscles may be relatively spared from the damage that can occur as a result of immobility, prolonged mechanical ventilation and systemic inflammation in critical illness.
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We report an unusual and emerging cause of profound hypokalaemia associated with a severe myopathy, attributable to misuse of Nurofen Plus, a readily available over-the-counter medication containing ibuprofen and codeine, and excessive ingestion of the caffeine-containing energy drink, Red Bull. The mechanism of the hypokalaemia may be ascribed to ibuprofen-mediated type 2 renal tubular acidosis, and caffeine-mediated antagonism of adenosine receptors or intercompartmental shift of potassium into the intracellular space. Practitioners should be aware that patients with codeine addiction who misuse Nurofen Plus may present with severe hypokalaemia complicated by myopathy.
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To develop a prediction model of 28-day mortality in adult intensive care units using administrative data. ⋯ Our P- model is robust and does not depend on disease identification. This is an advantage, as errors can arise in coding of primary diagnoses. Our model may facilitate mortality prediction based on administrative data collected on ICU patients.
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Inverted tako-tsubo cardiomyopathy (TTC) is a variation of stress cardiomyopathy. It features transient myocardial dysfunction characterised by a typical contractile abnormality consisting of extensive left ventricular circumferential dyskinesia or akinesia with a hyperkinetic apex. ⋯ The patient made a full recovery. Our case highlights that a reversible inverted TTC may result from an exogenous catecholamine surge.
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The role of extracorporeal membrane oxygenation (ECMO) in the treatment of the acute respiratory distress syndrome (ARDS) is controversial, notwithstanding the recent publication of the results of the CESAR (Conventional Ventilation or ECMO for Severe Adult Respiratory Failure) trial. Using Bayesian meta-analytic methods from three randomised controlled trials (RCTs) of ECMO in ARDS, we estimate the mortality odds ratio to be 0.78 (95% credible interval, 0.25-3.04), P (OR > 1) = 30%. ⋯ We conclude that the CESAR trial is problematic in terms of both the clinical and economic outcomes, although observational series suggest plausible efficacy. We suggest that ECMO finds rationale as rescue therapy and that the current uncertainty of its role mandates a further RCT.