Crit Care Resusc
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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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Case Reports
Cardiac arrest complicating neostigmine use for bowel opening in a critically ill patient.
Absence of bowel opening is common among critically ill patients. Neostigmine can be used to achieve stool passage after other treatments have been ineffective. Here, we report a case of cardiac arrest complicating neostigmine use in a 16-year-old woman with cerebral palsy who was being treated in the intensive care unit after orthopaedic surgery. Bradycardia is a recognised complication of neostigmine administration; however, cardiac arrest has not been reported previously.
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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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To measure and describe the extent and consequences of documented medical patient reviews in the 24 hours before a cardiac arrest, medical emergency team (MET) call or an unanticipated intensive care unit admission ("event"), and the use of such reviews as a rapid response system performance measure. ⋯ Medical reviews in the 24 hours before an adverse event are common. The type of medical review may influence patient outcome and thus may be a useful measure of rapid-response systems and critical care performance.