Crit Care Resusc
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The recent recognition of the myriad roles of vitamin D beyond those of bone health and calcium homoeostasis has resulted in a large body of clinical studies demonstrating an association between vitamin D deficiency and a number of adverse health outcomes. While these studies in chronic disease states have shown a strong association between vitamin D deficiency and poor outcomes, they have been unable to demonstrate cause and effect. ⋯ It is possible that low vitamin D levels may contribute to the acute multiorgan dysfunction seen in critical illness by similar mechanisms to those seen in chronic conditions. In this commentary, we briefly review the physiology of vitamin D, examine the evidence for association of hypovitaminosis with poor outcome in both ambulatory and intensive care unit patients, and debate the role of routine vitamin D supplementation in the ICU.
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Paracetamol is commonly administered to febrile critically ill patients with infection. However, there is limited information on the efficacy and safety of using paracetamol in this setting. We describe the study protocol for a Phase IIb multicentre randomised controlled trial (the Permissive Hyperthermia Through Avoidance of Paracetamol in Known or Suspected Infection in ICU [HEAT] trial) comparing intravenous paracetamol to placebo in the treatment of fever in critically ill adults with known or suspected infection. ⋯ The HEAT trial should generate results that will inform and influence the prescribing of paracetamol. It will also determine if a large-scale Phase III trial of paracetamol is required in this patient group and whether such a trial is feasible.
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Comparative Study
Magnesium flux during continuous venovenous haemodiafiltration with heparin and citrate anticoagulation.
To describe magnesium flux and serum concentrations in ICU patients receiving continuous venovenous haemodiafiltration (CVVHDF). ⋯ Exponential decline in magnesium concentrations was sufficiently rapid that subtherapeutic serum magnesium concentrations may occur well before detection when once-daily sampling was used. Measurements should be interpreted with regard to timing of magnesium infusions. We suggest that continuous renal replacement therapy fluids with higher magnesium concentrations be introduced in the critical care setting.