Acta Clin Belg
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We examined the process, consequences and impact of writing a Do-Not-Resuscitate (DNR) order in a cohort of critically-ill ICU patients. Special emphasis was given to the DNR order including withholding renal replacement therapy. A DNR code was mainly written in the first week following ICU admission and more often given to medical, older and sicker patients. ⋯ In our population, the final in-hospital mortality rate of DNR-coded patients was 100%, because the DNR status was ordered when the patients were already very sick. DNR-coded patients died after a longer mean length of ICU stay than patients without a code. Withholding renal replacement therapy was commonly added to the DNR order even if renal failure either was not present or never developed.
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Comparative Study
A cost-utility analysis of pregabalin in the management of peripheral neuropathic pain.
To assess the cost per QALY (quality-adjusted life years) of pregabalin in the management of peripheral neuropathic pain. ⋯ Based on this analysis, it may be concluded, that in the considered patient population, at the specialist level, pregabalin is at least cost neutral to current usual care (without AEDs) and offers a slight but significant increase in quality of life.
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Case Reports
Vertebral osteomyelitis with spinal epidural abscess in two patients with Bacteroides fragilis bacteraemia.
We report 2 cases of vertebral osteomyelitis and contiguous epidural abscess due to Bacteroides fragilis with no concomitant or past intra-abdominal infection. Decompressive surgery with laminectomy was required for both patients due to the occurrence of neurologic deficits. ⋯ In both cases, magnetic resonance imaging (MRI) has proved to be essential for diagnostic. The primary source of infection remained unknown despite careful investigations.
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Randomized Controlled Trial Comparative Study
Epidural analgesia decreases intraabdominal pressure in postoperative patients with primary intra-abdominal hypertension.
Surgical decompression is a lifesaving procedure in patients with severe intraabdominal hypertension. However, it involves subsequent management of an open abdomen. Therefore, it is not recommended for moderate intra-abdominal hypertension. Our literature search did not show any studies relating the efficacy of epidural analgesia in decreasing elevated intraabdominal pressure (IAP) in critically-ill surgical patients with primary intra-abdominal hypertension. ⋯ Continuous thoracic epidural analgesia decreases IAP and improves APP without haemodynamic compromise in postoperative critically-ill patients with primary intra-abdominal hypertension.