Crit Care Resusc
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To describe the longitudinal changes in documentation of advance care directives (ACDs), including limitation of medical therapy (LMT) and not-for-resuscitation (NFR) directives among patients reviewed by a medical emergency team (MET). ⋯ Compliance with hospital policy of universal documentation was low despite MET involvement. There was a strong association between ACDs and death, suggesting an opt-out culture. Further investigation is needed into the interaction between hospital systems, medical culture, human factors, and patient-centred clinical decision making.
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Review Meta Analysis
A systematic review of the accuracy of peripheral thermometry in estimating core temperatures among febrile critically ill patients.
There is uncertainty about the accuracy of peripheral thermometers in measuring temperatures within the febrile physiological range. ⋯ The identified studies suggest that in critically ill patients, tympanic and oral thermometry provide, on average, accurate measures of core temperatures within the febrile range and can be recommended for this purpose. Further studies with appropriate statistical methods are required to assess the accuracy of peripheral thermometers among critically ill patients with fever.
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To compare venous pressure and haemoglobin oxygen saturation measured from a catheter in the superior vena cava (SVC) with a catheter inserted via the femoral vein, and to assess the agreement of these measurements. To assess the effect of intra-abdominal pressure and intrathoracic pressures on these measurements. ⋯ This study demonstrates poor agreement between CVP and FVP and between SO₂C and SO₂F and that the measurements taken from these two sites are not interchangeable clinically.
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A pulse pressure variation (PPV) ≥ 13% of mean arterial pressure (MAP) is an accepted marker of a fluid-responsive state. However, there is no study of its epidemiology and associations among non-cardiac critically ill patients. ⋯ Among non-cardiac surgery mechanically ventilated patients, a PPV in the fluid-responsive range was present in one-fifth of measurements and showed logical correlations with relevant haemodynamic and mechanical ventilation-related variables. Our results provide a rationale for a more comprehensive evaluation of PPV measurement in suitable critically ill patients.
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There is little information on the use of paracetamol for septic critically ill patients. We hypothesised that paracetamol use is common in such patients, but its administration is not predictably related to body temperature. ⋯ Paracetamol administration is common among septic critically ill patients with or without fever, and more likely to occur when fever is present. However, paracetamol is not predictably given for the highest temperature in febrile patients. Future investigations are needed to understand under what circumstances and why paracetamol is given or not given to febrile or afebrile septic ICU patients.