Crit Care Resusc
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Multicenter Study Comparative Study
Inappropriate continuation of stress ulcer prophylaxis beyond the intensive care setting.
To determine how frequently stress ulcer prophylaxis (SUP) medications prescribed in the intensive care unit are inappropriately continued on the ward and on hospital discharge. ⋯ SUP medications commenced in ICU are frequently continued unnecessarily, both in the wards and hospital discharge.
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Comparative Study
Fluid balance does not predict estimated sodium balance in critically ill mechanically ventilated patients.
Distribution of total body water (TBW) depends on local and systemic factors including osmolality, relative sodium content and permeability. Although positive fluid balance has been associated with increased morbidity and mortality in critically ill patients, the mechanisms and relative roles of sodium balance and water distribution are uncertain. ⋯ Fluid balance may not reflect sodium balance in critically ill patients. As sodium balance correlates with respiratory dysfunction and increased extracellular volume, further studies examining sodium balance and morbidity seem warranted.
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Comparative Study
Improving communication of the daily care plan in a teaching hospital intensive care unit.
Patients admitted to intensive care units have complex care needs. Accordingly, communication and handover of the medical care plan is very important. ⋯ Introduction of a single-page, handwritten, structured daily care plan produced marked improvements in ICU nurses' self-reported understanding of elements of the medical plan, and may have reduced practice variation in medical plan documentation. The effects of this intervention on patient outcomes remain untested.
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Comparative Study
Characteristics and outcomes of patients subject to intensive care nurse consultant review in a teaching hospital.
To describe the evolution of our Intensive Care Nurse Consultant (ICNC) service, the characteristics and outcomes of the patients reviewed, and interventions performed. ⋯ Most interventions are relatively simple, and the ICNC role may be augmented by limited rights to prescribe electrolyte replacement. The effect of the intervention on patient outcomes and the reproducibility of our findings in other hospitals remain to be determined.
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Case Reports
Normothermic extracorporeal human liver perfusion following donation after cardiac death.
Liver transplantation is a major life-saving procedure and donation after cardiac death (DCD) has increased the pool of potential liver donors. However, livers procured after DCD are at increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to protect, evaluate and, in future, transplant DCD livers. ⋯ We achieved NELP with evidence of liver function (bile production, paracetamol removal and control of ammonia, bilirubin and lactate levels) for 3 hours. There was essentially normal liver and biliary tract histology after 8 hours of perfusion. Our experiment justifies further investigation of the feasibility and efficacy of human DCD liver preservation by NELP.