Crit Care Resusc
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To study the frequency, rationale and process for withholding (WH) and withdrawing (WD) life-sustaining therapies in intensive care patients in Ireland. ⋯ The frequency of withdrawal or withholding of therapy in this Irish ICU is in line with current international practice. The time to EOL decision-making is variable and relatively short compared with that in the United States, but similar to that in Europe. Clinicians are the primary initiators of the EOL decision in Ireland, with little patient involvement. Family members are more likely to initiate an EOL decision than in Europe. EOL decisions were usually made during "routine" working hours after significant consultation with all groups.
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Randomized Controlled Trial Comparative Study
A phase II randomised controlled trial of intensive insulin therapy in general intensive care patients.
To determine the safety and efficacy of an intensive insulin regimen compared with a conventional insulin regimen in general intensive care unit patients. ⋯ The intensive insulin regimen was effective in achieving the target blood glucose concentration, with clear separation from the conventional insulin regimen. Although the incidence of hypoglycaemia was increased, there was no detectable harm.
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Randomized Controlled Trial
Effect of heparin in arterial line flushing solutions on platelet count: a randomised double-blind study.
Arterial catheters are widely used in intensive care units for continuous blood pressure monitoring and blood sampling. Studies have examined the effect of heparin on patency of arterial catheters but not on platelet counts. Heparin is a naturally occurring anticoagulant that helps prevent clotting and is given to prevent and treat thrombosis. It has many other effects, including reducing platelet counts. ⋯ Use of heparin in normal saline as a continuous flush for an arterial catheter does not reduce platelet counts in critically ill patients.
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Review
Heparin-induced thrombocytopenia without thrombosis: an evidence-based review of current literature.
There has been a recent change in the management guidelines for patients with heparin-induced thrombocytopenia with the addition of a recommendation to commence parenteral anticoagulation in patients with isolated HIT without evidence of thrombosis. We assessed the evidence supporting this recommendation, to answer the following questions: in a patient with isolated HIT, should alternative anticoagulation be commenced, what alternative agent should be used, what is the recommended duration of anticoagulation, and when should warfarin be used? ⋯ Although patients with isolated HIT are at considerable risk of new thrombosis, there is limited evidence to support or reject the use of non-heparin anticoagulation in this group. Non-randomised, historically controlled trials support the use of lepirudin and argatroban; evidence favouring danaparoid is limited to large case series and one retrospective observational study. Duration of parenteral anticoagulation and warfarin use are guided by consensus opinion alone.