Crit Care Resusc
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Low tidal volume ventilation (LTVV) of 4-8 mL/kg of ideal body weight (IBW) reduces mortality in patients with acute respiratory distress syndrome, and, more recently, it has been recommended as the default therapy for all controlled ventilation. However, adherence to LTVV is poor. Barriers to adherence include not having height measurements taken or IBW calculated during admission. The aim of our project was to develop and validate a simple one step biometric measuring tool to directly estimate tidal volume (VT) in ventilated patients based on their demispan. ⋯ Estimating VT using of our biometric one step approach based on demispan correlates well with VT derived from vertical height. The simplicity of its use and accuracy could lead to improved adherence in a large cohort of patients who currently do not receive the recommended VT restriction.
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Randomized Controlled Trial Multicenter Study
A protocol for a phase 3 multicentre randomised controlled trial of continuous versus intermittent β-lactam antibiotic infusion in critically ill patients with sepsis: BLING III.
β-Lactam antibiotics display a time-dependent mechanism of action, with evidence suggesting improved outcomes when administering these drugs via continuous infusion compared with standard intermittent infusion. However, there is no phase 3 randomised controlled trial (RCT) evidence to support one method of administration over another in critically ill patients with sepsis. ⋯ The BLING III study will compare the effect on 90-day mortality of β-lactam antibiotics administered via continuous versus intermittent infusion in 7000 critically ill patients with sepsis.
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Comparative Study
Modifications to predefined rapid response team calling criteria: prevalence, characteristics and associated outcomes.
Standardised rapid response team (RRT) calling criteria may not be applicable to all patients, and thus, modifications of these criteria may be reasonable to prevent unnecessary calls. Little data are available regarding the efficacy or safety of modifying RRT calling criteria; therefore, this study aimed to detail the prevalence and characteristics of modifications to RRT call triggers and explore their relationship with patient outcomes. ⋯ Modifications to standard calling criteria were frequently made, but did not seem to prevent further RRT calls and were associated with increased mortality. These findings suggest that modifications should be made with caution.
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Lack of management guidelines for lifethreatening asthma (LTA) risks practice variation. This study aims to elucidate management practices of LTA in the intensive care unit (ICU). ⋯ In LTA, practice variation is common, with opportunities to improve discharge management plans and asthma education.
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Two major cardiac arrest trials are evaluating different strategies that may potentially mitigate neurological injury after cardiac arrest and are allowing co-enrolment. However, one trial will target hypothermia and the other will target mild hypercapnia, in which the carbon dioxide (CO2) measurement may be influenced by the choice of temperature adjustment during arterial blood gases (ABGs) measurement. The trials have agreed to standardise assessment by the α-stat method. ⋯ Our survey findings support the acceptability of the decision to apply the α-stat approach across participating sites for both trials.