Crit Care Resusc
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To evaluate the effect of fluid therapy using Accusol (Baxter Healthcare, McGaw Park, Ill, USA), a crystalloid solution containing sodium bicarbonate and other electrolytes and having a strong ion difference of 35 mEq/L, on acid-base stability after cardiac surgery. ⋯ SBE was more stable in patients treated with Accusol. Further studies are needed to determine whether use of solutions such as Accusol influences important patient outcomes.
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The correct renal response to metabolic acidosis should be a negative shift in the urinary strong ion difference ([SID](urinary) = [Na(+)](urinary) + [K(+)](urinary) - [Cl(-)](urinary)). Our hypothesis was that the failure to decrease the [SID](urinary) is frequently present and leads to a more severe metabolic acidosis. ⋯ Most of the critically ill patients with metabolic acidosis showed inappropriate renal compensation, as evidenced by positive [SID](urinary) and higher plasma [Cl(-)]. These patients had more severe metabolic acidosis. On the other hand, patients with adequate renal response and negative [SID](urinary) had positive Δ[AG] - Δ[HCO(3)(-)]. These findings, usually considered as a diagnosis of associated metabolic alkalosis, might be interpreted as the proper renal response to metabolic acidosis.
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Case Reports
Emergency use of extracorporeal membrane oxygenation for a foreign body obstructing the airway.
We report on the successful emergency use of extracorporeal membrane oxygenation to provide oxygenation and ventilation to a patient with lifethreatening airway obstruction, and then facilitating the removal of a tracheal food bolus by rigid bronchoscopy.
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To assess the frequency of after-hours discharges of patients from the intensive care unit and its effect on in-hospital mortality. ⋯ A high proportion of patients (34.7%) were discharged from the ICU after-hours. Discharge after-hours was associated with a higher risk of in-hospital mortality than discharge during work hours.
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Acute Physiology and Chronic Health Evaluation (APACHE) III scores have been shown to correlate with outcomes for patients with burn injuries. It is unknown whether they can be used to compare outcomes between intensive care units that admit patients with burns in Australia and New Zealand. ⋯ The APACHE III-j score is a good predictor of death among burns patients admitted to ICUs in Australia and New Zealand. It can be used to compare risk-adjusted outcomes between individual ICUs and over time.