Crit Care Resusc
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Multicenter Study
Communication with Families Regarding Organ and Tissue Donation after Death in Intensive Care (COMFORT): a multicentre before-and-after study.
To implement a best-practice intervention offering deceased organ donation, testing whether it increased family consent rates. ⋯ Implementation of a multicomponent intervention did not increase consent rates for organ donation, although some components of the intervention exerted significant effect.
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On 19 June 2019, the Voluntary Assisted Dying Bill 2017 (Vic) will be enacted. Up to ten per cent of people deemed eligible for voluntary assisted dying will be medically suitable for organ donation. ⋯ In particular, it discusses the ways in which organ donation will affect the place, timing and mechanism of death, and the ethics around consent for donation. The article explores potential ways to minimise warm ischaemic time, and finally discusses the potential for donation to influence the decision to consume the voluntary assisted dying substance.
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Inadvertent fluid loading - and resultant sodium and chloride - is common in critically ill patients. Sources such as fluid used as vehicles for drug infusions and boluses (fluid creep) and maintenance fluid are a common cause. We hypothesised that total sodium and chloride loading can be safely reduced in critically ill patients both by the use of 5% glucose as a diluent for infusions and boluses, when possible, and by its use as a maintenance fluid. ⋯ It is safely possible to decrease the total sodium and chloride loading to ICU patients by intervening on fluid creep and on maintenance fluid types. This intervention was accompanied by favourable changes in serum electrolyte and fluid balance.
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There is an increasing incidence of invasive candidal infections in critically ill patients worldwide, which has prompted development of various risk prediction rules, both clinical and microbiological. To date, however, there is a lack of research into how cumulative risk factors over time affect transition to candidaemia. The aim of this study was to investigate the association of risk factor accumulation over time with candidaemia in a cohort of critically ill, non-neutropenic adult patients. ⋯ This study demonstrates an association between TPN use, Candida colonisation and cumulative risk over time of developing candidaemia.