Crit Care Resusc
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Multicenter Study Observational Study
Intensive care implications of epidemic thunderstorm asthma.
To investigate the environmental precipitants, treatment and outcome of critically ill patients affected by the largest and most lethal reported epidemic of thunderstorm asthma. ⋯ Arrival of a triggering storm is associated with an increase in respirable airborne particles. Affected critically ill patients are young, have a high mortality, a short duration of bronchospasm, and a prior diagnosis of asthma is common.
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Tracheostomy is relatively common in mechanically ventilated patients in the intensive care unit (ICU). The prediction of which patients will receive a tracheostomy is crucial to both clinical decision making and the design of targeted interventional trials of its timing. ⋯ PROSPERO registry no. CRD42018084987.
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On 19 June 2019, the Voluntary Assisted Dying Bill 2017 (Vic) will be enacted. Up to ten per cent of people deemed eligible for voluntary assisted dying will be medically suitable for organ donation. ⋯ In particular, it discusses the ways in which organ donation will affect the place, timing and mechanism of death, and the ethics around consent for donation. The article explores potential ways to minimise warm ischaemic time, and finally discusses the potential for donation to influence the decision to consume the voluntary assisted dying substance.
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Inadvertent fluid loading - and resultant sodium and chloride - is common in critically ill patients. Sources such as fluid used as vehicles for drug infusions and boluses (fluid creep) and maintenance fluid are a common cause. We hypothesised that total sodium and chloride loading can be safely reduced in critically ill patients both by the use of 5% glucose as a diluent for infusions and boluses, when possible, and by its use as a maintenance fluid. ⋯ It is safely possible to decrease the total sodium and chloride loading to ICU patients by intervening on fluid creep and on maintenance fluid types. This intervention was accompanied by favourable changes in serum electrolyte and fluid balance.