Crit Care Resusc
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Randomized Controlled Trial Multicenter Study
The SPICE III study protocol and analysis plan: a randomised trial of early goaldirected sedation compared with standard care in mechanically ventilated patients.
Sedation strategy in critically ill patients who are mechanically ventilated is influenced by patient-related factors, choice of sedative agent and the intensity or depth of sedation prescribed. The impact of sedation strategy on outcome, in particular when delivered early after initiation of mechanical ventilation, is uncertain. ⋯ SPICE III is an ongoing large scale clinical trial. Once completed, it will inform sedation practice in critically ill patients who are ventilated.
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Falls among hospitalised patients contribute to avoidable morbidity and prolonged hospital stay. We aimed to describe the incidence, circumstances and outcomes associated with patient falls occurring in intensive care units. ⋯ Falls in the ICU are infrequent and generally perceived as avoidable. Falls often occur at night, are unwitnessed and are associated with concomitant patient delirium and nursing shift changes and cross coverage.
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To describe the technique and review the utility of bedside lung ultrasound in acute care. ⋯ Lung ultrasound is a useful point-of-care investigation in acute care, especially in patients with dyspnoea or haemodynamic instability. Although normal lung parenchyma is not accessible to ultrasound, distinctive artefacts arising from parietal and visceral pleura indirectly imply the presence of normal lung. As aeration of lung tissue reduces with disease process, visual assessment of several pathologic entities by ultrasound becomes possible. Ultrasound can be used for qualitative and quantitative assessment as well as to guide intervention. Compared with supine anteroposterior chest x-rays, lung ultrasound is faster and superior at ruling out pneumothorax and diagnosing lung consolidation, pleural effusions or pulmonary oedema. It is a logical and highly valuable extension of echocardiography and can be incorporated into diagnostic algorithms for assessment of dyspnoea, hypotension, chest pain or trauma. It provides rapid information about potentially reversible pathology in cardiac arrest scenarios. Other advantages include bedside availability, repeatability, provision of dynamic diagnostic information, ease of use and the absence of radiation exposure.