Crit Care Resusc
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A systematic review to examine the safety and efficacy of ultrasound before and/or during percutaneous dilatational tracheostomy (PDT). ⋯ There are currently no randomised controlled trials to establish the safety or efficacy of preprocedural and/or real-time intraprocedural ultrasound guidance during PDT compared with the current standard of care. One study supports the use of real-time ultrasound guidance during PDT in preventing cranial tracheostomy tube misplacement. Observational data suggest that preprocedural ultrasound may help prevent vascular complications and that real-time ultrasound guidance during PDT is likely safe, with a high success rate. A prospective randomised controlled trial evaluating its safety and efficacy compared with the traditional landmarkguided technique is required to establish its role in clinical practice.
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Patients who recover from critical illness may be left with significant limitations to their physical function that can have important consequences for their quality of life. Measures of physical function may be useful end points to consider in studies conducted in critically ill patients and are particularly attractive in studies investigating early mobilisation and rehabilitation. ⋯ A wide range of end points have been used to evaluate physical function in critically ill patients. However, further studies are needed to establish the measurement properties of the most commonly used end points in order to recommend their use in clinical trials.
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The recent recognition of the myriad roles of vitamin D beyond those of bone health and calcium homoeostasis has resulted in a large body of clinical studies demonstrating an association between vitamin D deficiency and a number of adverse health outcomes. While these studies in chronic disease states have shown a strong association between vitamin D deficiency and poor outcomes, they have been unable to demonstrate cause and effect. ⋯ It is possible that low vitamin D levels may contribute to the acute multiorgan dysfunction seen in critical illness by similar mechanisms to those seen in chronic conditions. In this commentary, we briefly review the physiology of vitamin D, examine the evidence for association of hypovitaminosis with poor outcome in both ambulatory and intensive care unit patients, and debate the role of routine vitamin D supplementation in the ICU.
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Paracetamol is commonly administered to febrile critically ill patients with infection. However, there is limited information on the efficacy and safety of using paracetamol in this setting. We describe the study protocol for a Phase IIb multicentre randomised controlled trial (the Permissive Hyperthermia Through Avoidance of Paracetamol in Known or Suspected Infection in ICU [HEAT] trial) comparing intravenous paracetamol to placebo in the treatment of fever in critically ill adults with known or suspected infection. ⋯ The HEAT trial should generate results that will inform and influence the prescribing of paracetamol. It will also determine if a large-scale Phase III trial of paracetamol is required in this patient group and whether such a trial is feasible.
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Comparative Study
Magnesium flux during continuous venovenous haemodiafiltration with heparin and citrate anticoagulation.
To describe magnesium flux and serum concentrations in ICU patients receiving continuous venovenous haemodiafiltration (CVVHDF). ⋯ Exponential decline in magnesium concentrations was sufficiently rapid that subtherapeutic serum magnesium concentrations may occur well before detection when once-daily sampling was used. Measurements should be interpreted with regard to timing of magnesium infusions. We suggest that continuous renal replacement therapy fluids with higher magnesium concentrations be introduced in the critical care setting.