Crit Care Resusc
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To assess the frequency of after-hours discharges of patients from the intensive care unit and its effect on in-hospital mortality. ⋯ A high proportion of patients (34.7%) were discharged from the ICU after-hours. Discharge after-hours was associated with a higher risk of in-hospital mortality than discharge during work hours.
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Unplanned admission to the intensive care unit has been shown to significantly increase the risk of inhospital mortality. Medical advances and increased expectations have resulted in a greater number of very elderly patients (80 years and over) being admitted to the ICU. The risk of in-hospital death associated with unplanned admission to the ICU in very elderly patients has not been clearly defined. ⋯ Unplanned admission to the ICU increases the risk of in-hospital mortality in very elderly patients. At least 50% of the risk of in-hospital death in this age group is attributable to a combination of unplanned ICU admission, comorbidity (≥1 comorbid condition), acute renal failure and respiratory failure.
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Extended daily diafiltration (EDDf) is a prolonged intermittent dialysis technique introduced as an alternative to continuous renal replacement therapy in critically ill patients. Although EDDf has the advantages of ease of use, low cost and patient tolerability, there is concern that the high blood and dialysate flow rates used with EDDf may precipitate haemodynamic instability. ⋯ EDDf did not significantly worsen haemodynamic stability in patients with sepsis during their treatment.
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Infusion of propofol often causes significant vasodilation, which is followed by a profound drop in blood pressure. However, the exact underlying molecular mechanisms of this clinically important phenomenon remain unclear. ⋯ Development of hypotension after systemic administration of propofol is mainly caused by its direct relaxation effect on vascular smooth muscle. This response is mainly mediated by activation of K(ATP) channels.
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Acute Physiology and Chronic Health Evaluation (APACHE) III scores have been shown to correlate with outcomes for patients with burn injuries. It is unknown whether they can be used to compare outcomes between intensive care units that admit patients with burns in Australia and New Zealand. ⋯ The APACHE III-j score is a good predictor of death among burns patients admitted to ICUs in Australia and New Zealand. It can be used to compare risk-adjusted outcomes between individual ICUs and over time.