Crit Care Resusc
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To evaluate the efficacy of methylene blue in raising mean arterial pressure in hypotensive patients. ⋯ Methylene blue increases arterial blood pressure and systemic vascular resistances in vasoplegic patients without a detrimental effect on survival.
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Sugammadex is the first selective antagonist to reverse neuromuscular blockade induced by rocuronium and vecuronium. The mechanism by which sugammadex works is superior to current neuromuscular block reversal strategies in terms of speed, efficacy and side effects. There is little contemporary guidance on the use of sugammadex in intensive care medicine. This review covers the key pharmacological features, clinical uses and cost- effectiveness in the context of intensive care practice.
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Multicenter Study
Objective patient-related outcomes of rapid-response systems - a pilot study to demonstrate feasibility in two hospitals.
To establish and test the feasibility of measurement of a comprehensive set of mutually exclusive outcomes in the 7 days after referral of patients to a rapid-response team (RRT), to facilitate audit and aid analysis of failure-to-rescue events. ⋯ It is possible to classify RRT episodes using readily available data, and areas with suboptimal performance can be targeted. Our matrix may additionally facilitate comparison of rapid-response systems.
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The long-term outcomes of intensive care for the growing elderly cohort are not well defined. We explored the predictive factors for 12-month mortality in elderly patients who were admitted to an intensive care unit within 24 hours of emergency department (ED) presentation. ⋯ Physiological parameters present on admission to the ICU including acute renal failure, the need for mechanical ventilation, a low GCS and high serum urea level, as well as age, have independent predictive value for 12-month mortality, but comorbidities were not predictive. This may help clinicians with decisions about who will benefit most from intensive care treatment.
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Comparative Study
Comparison of the diagnostic accuracy of measured and calculated free cortisol in acutely ill patients using the Coolens equation.
To investigate the agreement between two methods of measurement of plasma free cortisol in acutely ill patients; an indirect method using the Coolens equation, and direct measurement using high-performance liquid chromatography-tandem mass spectrometry, which is the gold standard. ⋯ The observed bias between the two methods is of a magnitude that would be expected to produce clinically relevant discrepancies. Due to the proportional nature of the error, adding a correction factor is not feasible. Results obtained from using the Coolens method to calculate free cortisol concentration in acutely ill patients should be interpreted with caution.