Crit Care Resusc
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To review patients managed in an intensive care unit diagnosed with dynamic left ventricular outflow tract obstruction without hypertrophic cardiomyopathy. ⋯ Dynamic left ventricular outflow tract obstruction without hypertrophic cardiomyopathy is not an uncommon cause of hypotension resistant to catecholamines in critically ill patients. The diagnosis is important because management which includes fluid loading, vasopressors and reducing catecholamine infusions, differs from the management of other causes of shock.
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To review the diagnosis and management of cardiac arrhythmias in a two-part presentation. ⋯ Supraventricular and ventricular tachycardias in the critically ill patient often have underlying disorders that precipitate their development (e.g. hypokalaemia, hypomagnesaemia, anti-arrhythmic proarrhythmia, myocardial ischaemia, etc). While antiarrhythmic therapy and cardioversion or defibrillation may be required to achieve sinus rhythm, correction of the associated abnormalities is also required.
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To measure airway pressures during closed system suctioning with the ventilator set to three differing modes of ventilation. ⋯ Closed system suctioning in volume control ventilation may result in elevations of end-expiratory pressure following catheter insertion and subatmospheric airway pressures during suctioning. Pressure control ventilation produces less elevation of end-expiratory pressure following catheter insertion and is less likely to be associated with subatmospheric airway pressures during suctioning. CPAP/pressure support has no effect on end-expiratory pressure following catheter insertion and subatmospheric airway pressures are largely avoided during suctioning.
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Patients with traumatic brain injury (TBI) have a high mortality and morbidity. This pilot study was undertaken to identify contributors to outcome in the early management of patients with TBI and to investigate the feasibility of a larger study. ⋯ Both initial GCS and severity of brain injury should be used to match TBI patients for injury severity in future studies. Lower initial GCS in deceased patients was likely due to greater severity of brain injury, although it is also possible that the lower GCS was due to decreased brain perfusion (perhaps reflecting inadequate resuscitation) in these patients. Volume of early fluid resuscitation, time to definitive therapy, and time of presentation to hospital may also be important determinants of patient outcome. A large case control outcome study is required to extend these observations.
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To undertake a prospective randomised controlled study to investigate whether there is any beneficial renal effect in the perioperative administration of mannitol in patients undergoing orthotopic liver transplantation. ⋯ We conclude that intraoperative mannitol does not help preserve renal function in the patient undergoing liver transplantation.