Crit Care Resusc
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Multicenter Study Observational Study
Sodium balance, not fluid balance, is associated with respiratory dysfunction in mechanically ventilated patients: a prospective, multicentre study.
Large positive sodium balances, independent of fluid balance, may lead to expanded extracellular fluid volumes and adverse clinical outcomes in the critically ill, including impaired oxygenation. ⋯ The cumulative positive sodium balance, not the cumulative positive fluid balance, is associated with respiratory dysfunction and an increased length of MV.
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Comparative Study
Analysis of performance and predictors of success in the final fellowship examination of the College of Intensive Care Medicine.
To analyse the performance and predictors of success in the final fellowship examination of the College of Intensive Care Medicine (CICM), and to compare the outcomes of international medical graduates (IMGs) attempting the CICM fellowship exam with those of local trainees, defined as those from Australia, New Zealand and Hong Kong (ANZ-HK). To compare the performance of IMGs from countries with comparable health care systems (CHS) with those from other countries (non-CHS). ⋯ A significant proportion of candidates appearing for the CICM fellowship examination are IMGs. Pass rates for trainees who have graduated from the ANZ- HK systems have a higher success rate in the fellowship examination. IMGs from a CHS country, or those who completed an ANZ primary have a much higher success rate compared with other IMGs.
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0.9% saline is the most commonly used intravenous (IV) fluid in the world but recent data raise the possibility that, compared with buffered crystalloid fluids such as Plasma-Lyte 148, the administration of 0.9% saline might increase the risk of developing acute kidney injury. ⋯ The SPLIT study program will provide preliminary data on the comparative effectiveness of using 0.9% saline v Plasma-Lyte 148 for IV fluid therapy in ED, surgical and ICU patients.
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Observational Study
Primary fluid bolus therapy for infectionassociated hypotension in the emergency department.
The physiological changes associated with fluid bolus therapy (FBT) for patients with infection-associated hypotension in the emergency department (ED) are poorly understood. We describe the physiological outcomes of FBT in the first 6 hours (primary FBT) for patients presenting to the ED with infection-associated hypotension. ⋯ Among ED patients admitted to an Australian teaching hospital with infection, hypotension was uncommon. FBT for hypotension was limited in volumes given and failed to achieve a sustained SBP of >100 mmHg in 40% of cases. In contrast, noradrenaline therapy corrected hypotension in all patients who received it.
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Observational Study
Cortisol responses at baseline and after corticotropin in acute aneurysmal subarachnoid haemorrhage: a prospective study.
Measurements of total plasma cortisol (TPC) in the acute phase of aneurysmal subarachnoid haemorrhage (aSAH) have suggested a high incidence of adrenal insufficiency (AI). ⋯ In the acute phase after aSAH, the FPC increase is fivefold greater than that of TPC. There is discordance between TPC and FPC responses to corticotropin. The prevalence of AI, as assessed by FPC measurements, is negligible. We advocate caution in the assessment of adrenal cortical function using measurements of TPC in this population.