Crit Care Resusc
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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.
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The systemic inflammatory response syndrome (SIRS) concept lacks sensitivity and specificity for guiding clinical practice and sepsis research. ⋯ Both SIRS and weighted SIRS score had low predictive ability for microbiologically confirmed infection. A more robust conceptual framework incorporating clinical, biochemical and immunological markers must be formulated and validated to better guide clinical practice and research. Clinicians' suspicions may be as good as any scoring system at identifying patients with infection and sepsis.
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Studies conducted before the conception of medical emergency teams (METs) revealed that cardiac arrests were often preceded by deranged vital signs. METs have been implemented in hospitals to review ward patients whose conditions are deteriorating in order to prevent adverse events, including cardiac arrest. Antecedents to cardiac arrests in a MET-equipped hospital have not been assessed. ⋯ In this 6-month audit, about half the patients with cardiac arrest may have been unsuitable for resuscitation, or had objective warning signs that were not acted on. Further improvements in advanced care planning and optimisation of MET activation may further reduce cardiac arrest calls at our hospital.