Crit Care Resusc
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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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Case Reports
Delayed and prolonged elevated serum paracetamol level after an overdose - possible causes and implications.
We report the case of a 29-year-old man who ingested about 50 g of standard-preparation paracetamol plus other medications. The serum paracetamol level remained low in the first 24 hours. It peaked 54 hours after ingestion and remained high for 5 days. ⋯ On Day 3, the patient's liver function deteriorated and a rising serum paracetamol level was noted; hence, an NAC infusion was reinitiated. Despite this, the patient developed fulminant hepatic failure. This case underlines the importance of monitoring paracetamol levels and liver function for at least 72 hours after a suspected large overdose of paracetamol before discontinuing NAC infusion.