Crit Care Resusc
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Mortality related to sepsis among critically ill patients remains high. Recent literature suggests that hypercapnia may affect the pathophysiology of sepsis. The effects of hypercapnia on sepsis are largely related to the direct effect of hypercapnic acidosis on immune function and, as a consequence, of increased cardiac output that subsequently leads to improved tissue oxygenation. ⋯ It appears from these very limited clinical data that hypercapnia may be associated with adverse outcomes. There are no clinical studies investigating clinical outcomes of hypercapnic acidosis or compensated hypercapnia in sepsis and septic shock in critical care settings, thus extrapolation of the experimental results to guide critical care practice is difficult. Clinical studies are needed, especially in critically ill patients, to define the effects of compensated hypercapnia and hypercapnic acidosis that may aid clinicians to improve the outcomes in sepsis.
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Fluid bolus therapy (FBT) is a widely used intervention in paediatric critical illness. The aim of this study was to describe the attitudes and practices towards FBT of paediatric intensive care doctors in Australia and New Zealand. ⋯ Paediatric intensive care doctors prefer 0.9% saline and 4% albumin for FBT. Heart rate and blood pressure are the most preferred markers to assess fluid responsiveness. Preferences for FBT in specific conditions exist.
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Comparative Study Observational Study
Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition.
Chlorhexidine gluconate (CHG) bathing has been reported to decrease bloodstream infections and colonisation of multidrug-resistant organisms (MROs) in intensive care units (ICUs). However, its effectiveness in an Australian setting has not been assessed. ⋯ In a tertiary Australian ICU, routine CHG bathing compared with triclosan did not affect the rates of ICU-acquired CLABSI or positive blood cultures. However, it significantly decreased the incidence of MRSA acquisition.
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Near-infrared spectroscopy (NIRS) has been used in clinical practice to assess regional cerebral tissue oxygen saturation (StcO2). There is no evidence whether repeated use of the same sensor affects StcO2 measurements. We aimed to assess whether there was a significant systematic decrease or increase in StcO2 when NIRS sensors were reused. ⋯ Repeated use of NIRS sensors measured StcO2 in different individuals for up to 10 days. There were no significant, systematic, persistent or progressive changes in StcO2 with extended use over time. Our findings suggest that StcO2 does not change with sensor reuse for up to 10 days.