Crit Care Resusc
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Liver transplantation is a major life-saving procedure, and donation after cardiac death (DCD) has increased the pool of potential liver donors. However, DCD livers are at increased risk of primary graft dysfunction and biliary tract ischaemia. ⋯ Using extracorporeal membrane oxygenation, parenteral nutrition, separate hepatic artery and portal vein perfusion, and physiological perfusion pressures, we achieved NELP and evidence of function (bile production, paracetamol removal, maintenance of normal ammonia and lactate levels) for 4 hours in pig livers subjected to 15 and 30 minutes of cardiac arrest before explantation. Our experiments justify further investigations of the feasibility and efficacy of human DCD liver preservation by ex-vivo perfusion.
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To develop an influenza pandemic ICU triage (iPIT) protocol that excludes patients with the highest and lowest predicted mortality rates, and to determine the increase in ICU bed availability that would result. ⋯ The iPIT protocol excludes patients with the lowest and highest ICU mortality, and provides increases in ICU bed availability. Adjusting the lower SOFA score exclusion limit provides a method of escalation or de- escalation to cope with demand.
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Comparative Study
Predicting energy expenditure in sepsis: Harris-Benedict and Schofield equations versus the Weir derivation.
Given the difficulties of using indirect calorimetry in many intensive care units, clinicians routinely employ predictive equations (the Harris-Benedict equation [HBE] and Schofield equation are commonly used) to estimate energy expenditure in critically ill patients. Some extrapolate CO(2) production (V CO(2)) and O(2) consumption (V O(2)) by the Weir derivation to estimate energy expenditure. These derivative methods have not been compared with predictive equations. ⋯ In a cohort of patients with sepsis, TEE values calculated by the HBE and Schofield equation matched reasonably well with MEE values derived from the Weir equation. Correlation was better in patients with less severe sepsis (SIRS and severe sepsis and APACHE II score < 25). Our results suggest that predictive equations have sufficient validity for ongoing regular use in clinical practice.
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To compare patients admitted from the emergency department (ED) directly to a ward (EDWard), the intensive care unit (EDICU) or stepdown (high dependency) unit (EDSDU) with patients admitted via the ED, but whose admission to an ICU (EDWardICU) or SDU (EDWardSDU) was preceded by a ward stay. ⋯ Patients discharged from the ED to a general ward and subsequently to an ICU or SDU had a mortality that exceeded that of ED patients admitted directly to the ICU or SDU. Further investigations are warranted to explain this excess mortality and ascertain the extent of potential preventability.