Crit Care Resusc
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Comparative Study Clinical Trial
Near-infrared spectroscopy of the thenar eminence: comparison of dynamic testing protocols.
Near-infrared spectroscopy of the thenar eminence (NIRSth) is a non-invasive bedside method for assessing tissue oxygenation. The vascular occlusion test (VOT) with a pressure cuff can be used to provide a dynamic assessment of the tissue oxygenation response to ischaemia. VOT has been applied to assess the microcirculation by NIRSth in critically ill patients. The optimal mode of performing such VOT, however, remains controversial. ⋯ The 3-minute VOT and the 40% StO(2) appear equivalent. However, the 3-minute VOT carries a degree of decreased patient discomfort and shorter overall duration of execution.
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Multicenter Study
Enteral nutrition in Australian and New Zealand intensive care units: a point-prevalence study of prescription practices.
Enteral nutrition (EN) is widely accepted as the preferred method for providing nutrition therapy to critically ill patients. However, optimal energy goals and the best way to achieve those goals are ill defined. ⋯ 1 kcal/mL and energy-dense formulations are administered with about equal frequency in Australian and New Zealand ICUs. This finding supports future research into the evaluation of optimal nutritional delivery amounts using EN formulations with differing energy concentrations.
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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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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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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.