Crit Care Resusc
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The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is emerging as the most frequently used tool for identifying delirium among critically ill patients. ⋯ In our hospital, the CAM-ICU detected delirium less often than unstructured delirium assessments made by qualified intensive care nurses.
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Fluid resuscitation with saline in severe sepsis is controversial. Hypertonic (3%) saline (HTS) may be superior to normal (0.9%) saline (NS). ⋯ In gram-negative sepsis, bolus resuscitation with HTS and NS have similar and transient systemic and regional haemodynamic effects, but no effects on renal perfusion and only short-lived effects on renal function. These findings challenge the physiological rationale for fluid bolus resuscitation in sepsis.
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To evaluate the effects of nitroglycerin (glyceryl trinitrate) on intestinal microcirculation during endotoxaemic shock. ⋯ In endotoxaemic sheep, low doses of nitroglycerin failed to improve the subtle but persistent villi hypoperfusion that remains present after fluid resuscitation.
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The Australian and New Zealand Intensive Care Society (ANZICS) guidelines for the determination of brain death involve clinical testing and/or the use of brain blood flow analysis techniques. Recently, there has been professional and lay discussion regarding the role of brain blood flow analysis in the determination of brain death. ⋯ Two sets of clinical testing is the most common method for determining brain death in Australian and New Zealand ICUs. A minority of units used some form of brain blood flow imaging. Based on these findings, all brain death certification is in accordance with ANZICS guidelines.
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To determine the attitudes of critical care clinicians in Australia and New Zealand towards fever management for critically ill patients with sepsis but without neurological injury. ⋯ There is considerable variability in attitudes to fever management with a reported tendency to act to reduce fever in febrile patients with sepsis. There was broad support for a clinical trial of fever management.