Crit Care Resusc
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Review Meta Analysis
Effect of active temperature management on mortality in intensive care unit patients.
To evaluate the effect of active temperature management on mortality, intensive care unit (ICU) and hospital length of stay, as well as the relative efficacy of antipyretic medications and physical cooling devices for achieving reductions in temperature in critically ill adults. ⋯ Active temperature management neither increased nor decreased mortality risk in critically ill adults. When the therapeutic goal is to reduce body temperature, physical cooling approaches may be more effective than pharmacological measures in critically ill adults.
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Randomized Controlled Trial Comparative Study
The comparative effects of 3% saline and 0.5M sodium lactate on cardiac function:a randomised, crossover study in volunteers.
To investigate the metabolic and cardiac effects of intravenous administration of two hypertonic solutions - 3% saline (SAL) and 0.5M sodium lactate (LAC). ⋯ The administration of SAL or LAC has opposing effects on acid base variables such as SID. Hypertonic fluid infusion lead to increased cardiac preload and performance with Sm, suggesting better left ventricular systolic function during LAC as compared with SAL. Lactated hypertonic solutions should be evaluated as resuscitation fluids.
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Multicenter Study Observational Study
Ventilation management in Victorian intensive care unit patients without acute respiratory distress syndrome.
The setting of tidal volume (VT) during controlled mechanical ventilation (CMV) in critically ill patients without acute respiratory distress syndrome (ARDS) is likely important but currently unknown. We aimed to describe current CMV settings in intensive care units (ICUs) across Victoria. ⋯ In adults without ARDS undergoing CMV in Australian ICUs, the initial VT was a stereotypical 500 mL in one-third of participants, irrespective of sex. Moreover, around 40% of patients were exposed to an initial VT-PBW > 8.0 mL/kg. Finally, women were more likely to be exposed to a high VT and hyperventilation.
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The search for biomarkers has been described as a dismal patchwork of fragmented research. We review biomarkers in sepsis in the critically ill in terms of conventional single circulating proteins. Despite sepsis biomarker publications trebling over the past 6 years, currently only one, procalcitonin, has materialised promise. ⋯ The standing of gene signatures in the paradigmatic discipline, breast cancer, is described. Uncertainties in the understanding of the sepsis process are documented - the dissociation between blood and tissue element activity, or compartmentalisation. The paradox of the active search for gene signatures to refine the sepsis phenotype and discover target subtypes for new therapies in the absence of such therapies is presented.