Crit Care Resusc
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Observational Study
A prospective observational study of the effect of critical illness on ultrastructural and microscopic morphology of duodenal mucosa.
Disturbed intestinal barrier function due to 'leaky' tight junctions may cause secondary sepsis via paracellular translocation across the gut wall. Our objective was to describe the effects of critical illness on duodenal morphology and ultrastructure. ⋯ We did not detect any morphological abnormalities of duodenal tight junctions in critically ill patients. Our results should be interpreted with caution because of the small sample population, but our observations challenge the concept that paracellular translocation facilitates secondary sepsis.
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Comparative Study
Bedside lung ultrasound, mobile radiography and physical examination: a comparative analysis of diagnostic tools in the critically ill.
To compare lung ultrasonography (LUS), chest xray (CXR) and physical examination (Ex) for the detection of pathological abnormalities in the lungs of critically ill patients. ⋯ There was only fair-to-moderate agreement between LUS, CXR and Ex in detecting pulmonary abnormalities, including pleural effusion, lung consolidation and AIS. The higher rate of detection from LUS, combined with its ease of use and increasing accessibility, makes for a powerful diagnostic tool in the ICU.
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Diabetes mellitus and blood glucose level (BGL) are emerging as important prognosticators of outcome in critically ill patients. We evaluated the effect of diabetes and pre-hospital BGL on survival to hospital discharge and on 12-month functional recovery after out-of-hospital cardiac arrest (OHCA). ⋯ Diabetes affects at least one in five patients who have had an OHCA and is associated with poorer survival and 12-month functional recovery after OHCA. In comparison, an elevated pre-hospital BGL is common in the peri-arrest period and may be associated with improved outcomes.
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Observational Study
Is impaired cerebrovascular autoregulation associated with outcome in patients admitted to the ICU with early septic shock?
To investigate the correlation between early changes in cerebrovascular autoregulation (CVAR) and neurological outcome and mortality in patients admitted to the intensive care unit with septic shock. ⋯ CVAR is impaired early in septic shock and is independently associated with mortality at 3-month follow-up. Information based on bedside monitoring of CVAR in the ICU could form a valuable adjunct to guide haemodynamic optimisation in patients with septic shock.
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To describe changes in the use of intravenous (IV) fluid by quantity and type in different regions of Australia and New Zealand. ⋯ The amount and type of IV fluid use, as determined by fluid sales, is highly variable across Australia and New Zealand. However, overall use of balanced crystalloid solutions is increasing and the use of HES has decreased dramatically.