Crit Care Resusc
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Comparative Study
Assessment of the clinical utility of an ultrasonic monitor of cardiac output (the USCOM) and agreement with thermodilution measurement.
To assess the clinical utility of an ultrasonic monitor of cardiac output (USCOM), its reliability in tracking cardiac output (CO) changes and agreement with thermodilution (TD) measurements of CO. ⋯ Poor agreement with TD and a substantial rate of failure to obtain an USCOM measurement suggest that this device is unsuitable as a monitoring tool in intensive care.
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Comparative Study
Urinary glutathione S-transferase as an early marker for renal dysfunction in patients admitted to intensive care with sepsis.
Diagnosis of acute kidney injury (AKI) relies on measurement of serum creatinine concentration and urine flow, which change slowly and have low specificity and sensitivity. We investigated the potential of urinary levels of alpha-glutathione S-transferase (alpha-GST) and pi-GST - markers of proximal and distal renal tubule damage, respectively - to provide an earlier and more accurate indication of AKI in patients in the intensive care unit. ⋯ Urinary pi-GST is elevated early in all patients with sepsis syndrome, but is not predictive of AKI as defined by AKIN. This may indicate sensitive detection of an earlier phase of kidney injury, and suggests that sepsis-related renal injury affects the distal tubules, giving new insights into the pathophysiology of AKI in sepsis.
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Comparative Study
Withdrawal of active treatment in intensive care: what is stopped - comparison between belief and practice.
To assess the methods of withdrawal of active treatment in intensive care patients and to compare surveyed practice with the beliefs of medical and nursing staff. ⋯ These results suggest a wide disparity between belief and practice, with variable documentation regarding end-of-life decision-making and treatment of patients for palliation in the ICU. Several guidelines have been published that might improve end-of-life care. We recommend a standardised approach to improve communication between medical and nursing staff.