Crit Care Resusc
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A reported association between extubation failure (EF) and increased hospital length of stay and mortality led us to assess outcome of EF in an Australian intensive care unit. ⋯ Our findings confirm an increased risk of adverse outcomes for patients with EF. We observed a comparatively low EF rate. Confirmation in similar patient cohorts is required.
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We examined long-term outcome of pulmonary function, exercise capacity and health-related quality of life (HRQoL) in patients with acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome (SARS). ⋯ The mortality of SARS-related ARDS is similar to the mortality of ARDS from other causes. A substantial number of patients with SARS-related ARDS survived without receiving mechanical ventilation. Patients had good recovery of pulmonary function and HRQoL.
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Comparative Study
Measurement of cardiac output with a non-invasive continuous wave Doppler device versus the pulmonary artery catheter: a comparative study.
Cardiac index remains an important measured variable used to optimise fluid and haemodynamic support in the postoperative cardiac setting. Recent developments in non-invasive continuous wave Doppler devices enable rapid assessment of cardiac index with decreased morbidity. This study aimed to determine the clinical utility of one such device, the USCOM device (USCOM Ltd, Sydney, NSW), in assessing cardiac index compared with invasive continuous measurements of cardiac index using a pulmonary artery (PA) catheter. ⋯ In a heterogeneous population of postoperative cardiac patients, non-invasive determination of cardiac index using USCOM had limited clinical utility. Doppler flow signal quality may have been affected by intrathoracic air, patient position and operator learning curve. Given accepted inherent inaccuracies of continuous cardiac output assessment, further investigation is required to validate the suitability of USCOM in this patient population.
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The use of catecholamines to defend and resuscitate patients with septic shock remains a cornerstone of intensive care medicine. The pharmacological support of the failing circulation during sepsis and septic shock should be directed at augmenting perfusion of vital organs and facilitating venous return, rather than peripheral arterial vasoconstriction. There appears to be a teleological rationale for primary use of catecholamines to augment failing endogenous neurohumoral and neuroendocrine cardiovascular systems. ⋯ Supplemental endocrine replacement therapy with low-dose corticosteroids and vasopressin appears biologically plausible and has an emerging role. Results of large-scale, high-quality trials of endogenous catecholamines for sepsis and septic shock are awaited. These may provide additional, important information for evidence-based guidelines, which currently remain of limited clinical utility.
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Comparative Study
Enteral nutrition versus glucose-based or lipid-based parenteral nutrition and tight glycaemic control in critically ill patients.
Early administration of nutrition and attention to tight glycaemic control are both associated with improved outcomes in critically ill patients. We hypothesized that blood glucose control would be better achieved in patients receiving enteral rather than parenteral nutrition and, in the latter group, would be better achieved using a "balanced" glucose plus lipid solution than a dextrose-based solution as calorie source. ⋯ When used in association with a tight glycaemic control regimen, PN is not associated with poorer glycaemic control in critically ill patients than EN.