Crit Care Resusc
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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.
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To determine whether a detailed feeding algorithm improved nutrition support of critically ill patients compared with a standard feeding protocol. ⋯ Introduction of a detailed feeding algorithm resulted in earlier commencement of nutrition support and increased numbers of patients reaching goal rates in less time. To improve nutritional adequacy, the algorithm needs to be modified to account for unavoidable interruptions during ICU stay.
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To develop a prediction model of 28-day mortality in adult intensive care units using administrative data. ⋯ Our P- model is robust and does not depend on disease identification. This is an advantage, as errors can arise in coding of primary diagnoses. Our model may facilitate mortality prediction based on administrative data collected on ICU patients.
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We report an unusual and emerging cause of profound hypokalaemia associated with a severe myopathy, attributable to misuse of Nurofen Plus, a readily available over-the-counter medication containing ibuprofen and codeine, and excessive ingestion of the caffeine-containing energy drink, Red Bull. The mechanism of the hypokalaemia may be ascribed to ibuprofen-mediated type 2 renal tubular acidosis, and caffeine-mediated antagonism of adenosine receptors or intercompartmental shift of potassium into the intracellular space. Practitioners should be aware that patients with codeine addiction who misuse Nurofen Plus may present with severe hypokalaemia complicated by myopathy.
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The role of extracorporeal membrane oxygenation (ECMO) in the treatment of the acute respiratory distress syndrome (ARDS) is controversial, notwithstanding the recent publication of the results of the CESAR (Conventional Ventilation or ECMO for Severe Adult Respiratory Failure) trial. Using Bayesian meta-analytic methods from three randomised controlled trials (RCTs) of ECMO in ARDS, we estimate the mortality odds ratio to be 0.78 (95% credible interval, 0.25-3.04), P (OR > 1) = 30%. ⋯ We conclude that the CESAR trial is problematic in terms of both the clinical and economic outcomes, although observational series suggest plausible efficacy. We suggest that ECMO finds rationale as rescue therapy and that the current uncertainty of its role mandates a further RCT.