Crit Care Resusc
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Venous air embolism is a rare but life-threatening complication of continuous venovenous haemofiltration. We report a case of massive venous air embolism associated with haemofiltration in a 75-year-old man after complicated cardiac surgery. ⋯ We discuss our early intervention, which focused on restoration of the circulation, prevention of further air entry, retrieval of air and supportive care. The use of transoesophageal echocardiography for diagnosis of air embolism and to aid the insertion of a pulmonary artery catheter for air aspiration was essential for management.
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Comparative Study
Comparison of automated and static pulse respiratory mechanics during supported ventilation.
To compare respiratory mechanics estimated by the (pulse) technique in spontaneously breathing patients during proportional assist ventilation (PAV) with load-adjustable gain factor (PAV+) mode with those measured using the flow-interruption technique during controlled ventilation. ⋯ Based on these data, respiratory mechanics estimated from the (pulse) technique are too inaccurate to be clinically useful.
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Case Reports
High cut-off and high-flux membrane haemodialysis in a patient with rhabdomyolysis-associated acute kidney injury.
In a patient with rhabdomyolysis-associated anuric acute kidney injury, an 8-hour haemodialysis session was performed with a large-pore, high cut-off (HCO) membrane (in-vivo cutoff, 60 kDa). Subsequently, during another 8-hour dialysis session, a standard high-flux (HF) membrane (in-vivo cut-off, 15kDa) was used. ⋯ In contrast, myoglobin serum levels increased from 21430μg/L to 34336μg/L during HF haemodialysis. Thus, HCO haemodialysis achieved a reduction in serum myoglobin level that is superior to any other renal replacement technique so far.
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To evaluate the uptake of an emergency department early warning system (ED EWS) for recognition of, and response to, clinical deterioration. ⋯ The ED EWS resulted in at least two formal reports of clinical deterioration in ED patients per day, indicating reasonable uptake by clinicians. A greater understanding of clinical deterioration in ED patients is warranted to inform an evidence-based approach to recognition of, and response to, clinical deterioration in ED patients.
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To investigate the prevalence and clinical significance of upper gastrointestinal (UGI) findings during endoscopic placement of postpyloric feeding tubes in intensive care patients. ⋯ Endoscopic placement of postpyloric feeding tubes resulted in the identification of a significant number of patients with previously undiagnosed UGI abnormalities.