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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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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Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis causes autonomic disturbances, behavioural changes and abnormal movements. It is often a paraneoplastic phenomenon that occurs in association with ovarian teratomas and is the most common paraneoplastic encephalitis. ⋯ The remaining patients made substantial or complete neurological recoveries. This case series highlights that patients with anti-NMDA receptor encephalitis: • often require long periods of support in an intensive care unit; • may develop tracheostomy complications related to hypersalivation; • may develop life-threatening hyperthermia; • can have ovarian teratomas despite normal investigations; and • often have very abnormal movements that are difficult to control and make ongoing care difficult.