Crit Care Resusc
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Extracorporeal membrane oxygenation (ECMO) is a controversial means of life support, particularly in adults. Ongoing refinements in circuit technology and widening global experience have led to ECMO being applied to a broader group of conditions than acute respiratory failure and cardiogenic shock. Septicaemia is no longer viewed as a contraindication to ECMO. ⋯ The last indication is generally more applicable in children than adults, because of differences in the cardiovascular response to severe sepsis seen across age groups. ECMO has a role as rescue therapy in patients with severe sepsis who would otherwise die of either hypoxaemia or inadequate cardiac output. This review describes the basic technique and application of ECMO in neonates, older children, and adults with sepsis.
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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.
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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.