Crit Care Resusc
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Low tidal volume ventilation (LTVV) of 4-8 mL/kg of ideal body weight (IBW) reduces mortality in patients with acute respiratory distress syndrome, and, more recently, it has been recommended as the default therapy for all controlled ventilation. However, adherence to LTVV is poor. Barriers to adherence include not having height measurements taken or IBW calculated during admission. The aim of our project was to develop and validate a simple one step biometric measuring tool to directly estimate tidal volume (VT) in ventilated patients based on their demispan. ⋯ Estimating VT using of our biometric one step approach based on demispan correlates well with VT derived from vertical height. The simplicity of its use and accuracy could lead to improved adherence in a large cohort of patients who currently do not receive the recommended VT restriction.
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Two major cardiac arrest trials are evaluating different strategies that may potentially mitigate neurological injury after cardiac arrest and are allowing co-enrolment. However, one trial will target hypothermia and the other will target mild hypercapnia, in which the carbon dioxide (CO2) measurement may be influenced by the choice of temperature adjustment during arterial blood gases (ABGs) measurement. The trials have agreed to standardise assessment by the α-stat method. ⋯ Our survey findings support the acceptability of the decision to apply the α-stat approach across participating sites for both trials.
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Prognostication in patients with post-hypoxic brain injury remains difficult; yet, clinicians are commonly asked to guide decisions regarding withdrawal of life support. We aimed to assess whether electroencephalogram (EEG) is a useful tool in predicting neurological outcome in patients with post-hypoxic myoclonus (PHM). ⋯ This study shows that PHM is associated with a poor but not universally fatal prognosis. Early EEG does not reliably distinguish between good and poor outcomes.
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The purpose of this study was to evaluate if vitamin D deficiency is associated with increased rates of persistent critical illness, and whether repletion of vitamin D among patients with this deficiency leads to decreased persistent critical illness. ⋯ Vitamin D deficiency was not associated with persistent critical illness, nor did supplementation with vitamin D3 mitigate the development of persistent critical illness.
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Lack of management guidelines for lifethreatening asthma (LTA) risks practice variation. This study aims to elucidate management practices of LTA in the intensive care unit (ICU). ⋯ In LTA, practice variation is common, with opportunities to improve discharge management plans and asthma education.