Crit Care Resusc
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Comparative Study
Induced hypothermia after out-of-hospital cardiac arrest: one hospital's experience.
Induced mild hypothermia has been shown to reduce in-hospital mortality and to improve neurological outcome in patients who remain comatose after out-ofhospital cardiac arrest (OHCA). We conducted a retrospective audit to assess whether induced hypothermia had been successfully incorporated into routine care at our hospital, and whether this improved patient outcomes. ⋯ We found that induced hypothermia can be incorporated into routine care of patients admitted to an ICU after OHCA. For patients with an initial rhythm of VF or uVT, this seems to have significantly improved hospital survival and neurological outcome. We also found that rapid infusion of cold intravenous fluids was effective for inducing hypothermia.
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To develop an outcome measure as a basis for prescribing and evaluating rehabilitation in the critically ill, and to measure its reliability and responsiveness to change. The study also aimed to assess the feasibility and safety of a pilot exercise training protocol in an intensive care unit. ⋯ The PFIT is a reliable and responsive outcome measure, and the pilot training protocol was safe and feasible. As exercise may attenuate weakness and functional impairment, the PFIT can be used to prescribe and evaluate exercise and mobilisation. Future research should aim to develop a PFIT score and investigate the ability of the PFIT to predict ICU readmission risk and functional outcome.
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To evaluate outcomes of patients admitted to an intensive care unit with idiopathic pulmonary fibrosis (IPF) and acute respiratory deterioration. ⋯ Outcomes of patients with IPF admitted to the ICU are poor. Indications for mechanical ventilation appear uncertain.
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Despite government encouragement for patients to make advance plans for medical treatment, and the increasing numbers of patients who have done this, there is little research that examines how doctors regard these plans. ⋯ Many intensive care doctors believe end-oflife decisions remain medical decisions, and MEPAs and ACPs need only be respected when they accord with the doctor's treatment decision. This study suggests a need for further education of doctors, particularly those working in intensive care, who are responsible for initiating and maintaining life support treatment.
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The Fellowship Examination for Intensive Care Medicine in Australian and New Zealand, first held in 1979, has undergone four distinct periods of development and change: * 1979-1996. Initiation and establishment of the exam as a relevant and comprehensive assessment process for a new specialty. * 1997-2001. (*) Revision to increase breadth of coverage and reliability for a growing number of candidates, and to ensure that each candidate received the same exam. (*) Expansion to incorporate assessment of CanMEDS skills, including communication, procedures and professional qualities. (*) Lengthening to increase the number of exposures, to ensure reliability. (*) Quarantining of candidates to allow the provision of a similar exam for each candidate. * 2002-2006. Increasing emphasis on examiner training and standard setting, increasing feedback to candidates to improve the educational experience and guide exam preparation, and blueprinting of questions to maintain validity. * 2007 onwards. ⋯ The exam has been regarded as a "tough but fair" assessment in its 30 years of existence, and the committee overseeing its development has aimed to continually review the process to maintain those qualities, as well as reliability, validity and feasibility. The increasing number of candidates has allowed usable statistics to be accumulated but has tested the feasibility of running such a labour-intensive exam. To date, there have been 800 presentations to the exam, with 498 successful candidates.