Crit Care Resusc
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To determine whether the introduction of a weekly multidisciplinary team meeting (MDTM) to a general intensive care unit improved selected clinical indicators of patient outcome, and staff satisfaction with patient care. ⋯ The introduction of a weekly MDTM to a general ICU did not improve selected clinical indicators of patient outcome or staff satisfaction with patient care.
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To investigate the presence and determinants of femoral-radial gradients in mean arterial pressure (MAP) in a critically ill population. ⋯ A systematic difference in MAP measured at the radial and femoral sites was demonstrated. In some critically ill patients, the femoral artery may be the preferred site for systemic arterial pressure monitoring.
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Biography Historical Article
19th century pioneering of intensive therapy in North America. Part 3: the Fell-O'Dwyer apparatus and William P Northrup.
Two previous articles in this series have described the reintroduction of forced respiration for ventilatory difficulties, particularly in opiate poisoning (by George Fell), and successful use of intralaryngeal tubes designed for treating airway obstruction in diphtheritic acute laryngitis (by Joseph O'Dwyer). In 1891, O'Dwyer extended the applications of Fell's system, introducing a longer orolaryngeal tube, replacing Fell's methods of inflating the lungs, which had been with a somewhat unsatisfactory facemask or through a tracheotomy tube. ⋯ Although the apparatus was used beyond New York (eg, in New Orleans by J D Bloom, especially for neonatal apnoea), it is difficult to find other than nonspecific references. Matas and Bloom improved O'Dwyer's original system, but after the clinical success of Charles Elsberg's continuous insufflation anaesthesia for thoracic surgery, 1909, American anaesthetists came to prefer that.
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Randomized Controlled Trial
Pilot randomised double-blind controlled trial of high-dose spironolactone in critically ill patients receiving a frusemide infusion.
Hypernatraemia may develop during intravenous infusion of frusemide. Spironolactone is an aldosterone antagonist that promotes natriuresis and may attenuate such hypernatraemia, but its effect in this setting has not been previously studied. ⋯ In this pilot study, the administration of high-dose spironolactone to ventilated critically ill patients receiving frusemide by infusion had no significant effects on serum sodium level, natriuresis or potassium balance when compared with placebo.
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Multicenter Study
Prediction of death after withdrawal of life-sustaining treatments.
To assess the predictive value of respiratory and haemodynamic variables and opinion of the intensivist for determining how soon death occurs after withdrawal of life-sustaining treatments (WLST). ⋯ It is possible to predict the time from WLST to death accurately using a tool that combines GCS, respiratory and haemodynamic parameters and intensivist opinion. These results require validation in a large multicentre study.