Crit Care Resusc
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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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Donation after cardiac death (DCD) has increased faster than donation after brain death (DBD) in Australia. However, DBD is the preferred pathway because it provides more organs per donor, the donation process is simpler and transplant outcomes are optimised. ⋯ In Australia, brain-injured donors appear to be ventilated long enough to allow progression to brain death before proceeding to DCD. Therefore, DCD is unlikely to have reduced the brain-dead donor pool.
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To compare patient outcomes in hospitals certified by the Japanese Society of Intensive Care Medicine (JSICM) as training facilities for intensive care specialists with patient outcomes in hospitals not certified by the JSICM (non-CFs). ⋯ Patients admitted to the intensive care unit in CFs had better outcomes. To improve patient outcomes, more board-certified intensivists are required in Japan.
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Bolus dose concentrations of hydrocortisone (50mg/mL) are reported to be incompatible with midazolam and ciprofloxacin in Y-site mixing studies. We evaluated the physical and chemical compatibility of low concentrations of hydrocortisone sodium succinate (1 mg/ mL) with midazolam (1 mg/mL and 2mg/mL) and ciprofloxacin (2 mg/mL) solutions during a simulated Y-site administration study. ⋯ According to currently recommended criteria, combining hydrocortisone sodium succinate at a concentration of 1mg/mL with a 1mg/mL solution of midazolam appears to be both chemically and physically compatible. However, mixing 1mg/mL hydrocortisone sodium succinate with 2mg/mL midazolam or with 2mg/ mL ciprofloxacin cannot be recommended.