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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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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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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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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Most studies of Rapid-Response Teams (RRTs) assess their effect on outcomes of all hospitalised patients. Little information exists on RRT activation patterns or why RRT calls are needed. Triage error may necessitate RRT review of ward patients shortly after hospital admission. RRT diurnal activation rates may reflect the likely frequency of caregiver visits. ⋯ About one-quarter of RRT calls occurred shortly after hospital admission, and were more common when caregivers were around. Early calls may partially reflect suboptimal triage, though the associated mortality appeared low. Late calls may reflect suboptimal end-of-life care planning, and the associated mortality was high. There is a need to further assess the epidemiology of RRT calls at different phases of the hospital stay.