Crit Care Resusc
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To determine whether hyperglycaemia is associated with prolongation of the corrected QT (QTc) interval on the electrocardiogram (ECG) in critically ill patients. ⋯ There was a moderate, significant correlation between QTc and BGL. Patients with a QTc > 0.44 s had higher BGL, APACHE II score and mortality. BGL was an independent predictor of QTc duration, but neither BGL nor QTc were independent predictors of mortality in this study.
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To assess outcomes in patients with spinal cord injury (SCI) and a tracheostomy tube (TT), before and after the introduction of a tracheostomy review and management service (TRAMS) for ward-based patients. ⋯ Implementing a tracheostomy review and management service improved outcomes for SCI patients: they left acute care sooner, spoke sooner, and the TT was removed earlier, with associated cost savings.
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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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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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To determine the effect an intensive care unit liaison nurse service had on ICU patient discharges, readmissions and outcomes. ⋯ The introduction of our ICU liaison nurse service was associated with a trend towards more efficient ICU discharges (increased throughput, decreased ICU step-down days and ICU readmission LOS) and improved survival for ICU patients requiring readmission, but overall ICU and hospital LOS and mortality, and ICU readmission rates were unchanged.