Crit Care Resusc
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Historical Article
History of mouth-to-mouth ventilation. Part 3: the 19th to mid-20th centuries and "rediscovery".
The start of the 19th century saw the enthusiasm of the previous one for mouth-to-mouth ventilation (MMV) dissipated. To inflate the lungs of the asphyxiated, the Royal Humane Society in the United Kingdom had recommended bellows since 1782. Principal determinants for change were aesthetic distaste for mouth-to-mouth contact and the perceived danger of using expired air, although MMV survived in the practice of some midwives. ⋯ Ready adoption of MMV in the US was followed by worldwide spread, especially after endorsement from the 1962 international symposium at Stavanger in Norway. However, already there were occasional rumblings of reluctance to perform MMV. In this article, I consider MMV also in the context of other ventilatory modes for resuscitation.
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Over the past 12 years, the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group and the broader intensive care community in Australia and New Zealand have established a track record for conducting high quality, investigator-initiated clinical research in critically ill patients. This is highlighted by the publication of the SAFE (Saline Albumin Fluid Evaluation) study in the New England Journal of Medicine and the MERIT (Medical Early Response Intervention and Therapy) study in the Lancet. Here, we discuss potential impediments to the further advancement of intensive care research in Australia and New Zealand, and suggest strategies to address them. ⋯ We contend that the best chance of improving outcomes in many disease states requires studies to commence before patients enter the ICU, which will depend on collaboration with established and emerging craft groups, such as ambulance services, emergency medicine and anaesthesia. We also emphasise the need to study system factors affecting patient outcomes, as well as the translation of research findings into clinical practice. Finally, we describe the establishment and objectives of the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) and outline the Centre's current projects in the context of an integrated research framework.
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To quantify flow irregularities in drug delivery caused by vertical displacement of syringe pumps. ⋯ Vertical displacement of a common syringe pump by 30 cm produced significant bolus and cessation phenomena. These findings confirm the observations of previous authors and also demonstrate significant flow irregularities with smaller vertical displacements than previously tested. Further testing with other brands of pumps is required before a solution to this clinically important problem may be approached.
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Withdrawal of potentially life-prolonging treatments is a common procedure in most intensive care units. Until recently, quality improvement activities have been hampered by the absence of a clear sense of "best practice" in this complex area. ⋯ A current ICU quality improvement review lists EOL management as a possible audit item (Curtis et al. Crit Care Med 2006; 34: 211). Our study demonstrated the feasibility of developing a quality improvement tool for EOL decision-making and applying it in the intensive care setting. As evidence about the process of EOL decisionmaking accumulates, that process should become a component of quality assurance audit in intensive care.
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Procalcitonin (PCT) is a precursor of the hormone calcitonin and has been proposed as a marker of infection in critically ill patients. We evaluated the role of procalcitonin in the early detection of sepsis in an Australian intensive care-high dependency unit (ICU/HDU). ⋯ The use of PCT as a screening test (PCT >0.85ng/dL) in conjunction with traditional criteria is of value in the early diagnosis of bacterial sepsis in suspected cases in the ICU. PCT appears to be a reliable diagnostic test for bacterial sepsis at levels > 10 ng/dL.