Crit Care Resusc
-
Unplanned admission to the intensive care unit has been shown to significantly increase the risk of inhospital mortality. Medical advances and increased expectations have resulted in a greater number of very elderly patients (80 years and over) being admitted to the ICU. The risk of in-hospital death associated with unplanned admission to the ICU in very elderly patients has not been clearly defined. ⋯ Unplanned admission to the ICU increases the risk of in-hospital mortality in very elderly patients. At least 50% of the risk of in-hospital death in this age group is attributable to a combination of unplanned ICU admission, comorbidity (≥1 comorbid condition), acute renal failure and respiratory failure.
-
Extended daily diafiltration (EDDf) is a prolonged intermittent dialysis technique introduced as an alternative to continuous renal replacement therapy in critically ill patients. Although EDDf has the advantages of ease of use, low cost and patient tolerability, there is concern that the high blood and dialysate flow rates used with EDDf may precipitate haemodynamic instability. ⋯ EDDf did not significantly worsen haemodynamic stability in patients with sepsis during their treatment.
-
Haemodynamic instability is frequently considered a contraindication to enteral feeding. However, gastrointestinal function and the success of enteral feeding have never been formally examined in patients with shock. ⋯ Despite delayed gastric emptying, protocoldirected enteral feeding can be considered in patients with septic shock.
-
To evaluate the impact of a recruitment manoeuvre (RM) on haemodynamics, gas exchange, and oxygen transport in patients with acute lung injury (ALI) an acute respiratory distress syndrome (ARDS) under mechanical ventilation. ⋯ In our small series of patients with ALI/ARDS ventilated with high levels of PEEP, the RM failed to improve oxygen exchange and induced deleterious effects on haemodynamics.
-
Metformin, a widely used hypoglycaemic agent in type 2 diabetes mellitus, is uncommonly associated with lactic acidosis, a serious condition with high mortality. ⋯ MALA is a not uncommon cause of ICU admission. Gastrointestinal symptoms predominate in MALA, and the condition is associated with significant morbidity and mortality.