Crit Care Resusc
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Comparative Study
Continuous intra-arterial blood glucose monitoring using quenched fluorescence sensing: a product development study.
Continuous glucose monitoring (CGM) has the potential to improve the management of blood glucose (BG) and so improve patient safety and outcomes in intensive care units. The GluCath Intravascular CGM (IV-CGM) System (GluMetrics) uses a novel quenched chemical fluorescence sensing mechanism to measure BG. ⋯ In this product development study, use of the GluCath system for 24 hours after cardiac surgery had no adverse effect on haemodynamic monitoring, arterial blood sampling or clinical care. Overall accuracy was acceptable in the context of the first phase of a product development study.
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In critically ill patients, glycaemic variability (GV) was reported as a better predictor of mortality than mean blood glucose level (BGL). We compared the ability of different GV indices and mean BGLs to predict mortality and intensive care unit-acquired infections in a population of ICU patients. ⋯ High GV is associated with higher risk of ICUCrit acquired infection and mortality.
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Comparative Study
Systemic and renal haemodynamic effects of fluid bolus therapy: sodium chloride versus sodium octanoate-balanced solution.
Solutions with high chloride concentrations, like normal saline (NS), may adversely affect renal blood flow (RBF). We compared the systemic and renal haemodynamic effects of a bolus of NS with those of a novel isotonic solution containing a physiological concentration of chloride and sodium octanoate (SOct) in healthy conscious sheep. ⋯ NS and SOct appear to have similar systemic haemodynamic effects. However, OS significantly increases RBF compared with normal saline.
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We present a 16-year-old male with severe acute respiratory and renal failure as a result of Goodpasture syndrome, requiring venovenous extracorporeal membrane oxygenation (VV-ECMO) for pulmonary haemorrhage. The patient received no systemic anticoagulation for 25 of 26 ECMO days (20 days consecutively) and suffered no coagulation-related adverse events. The patient had a subtherapeutic anticoagulation profile according to recommended ECMO guidelines during most of this time. The patient made a full recovery without respiratory compromise, ECMO circuit failure, thrombotic events or the need for ongoing haemodialysis.