Articles: outcome.
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Nursing in critical care · May 2007
Commentary: Saline versus Albumin Fluid Evaluation (SAFE) Investigators (2006). Effect of baseline serum albumin concentration on outcome of resuscitation with albumin or saline in patients in intensive care units: analysis of data from the saline versus albumin fluid evaluation (SAFE) study.
The objectives of this study were to determine whether outcomes of resuscitation with albumin or saline in the intensive care unit (ICU) depend on patients' baseline serum albumin concentration. In this study we analyse data from a double-blind, randomized controlled trial. ICUs of 16 hospitals in Australia and New Zealand were included. ⋯ No significant interaction was found between baseline serum albumin concentration as a continuous variable and the effect of albumin and saline on mortality. No consistent interaction was found between baseline serum albumin concentration and treatment effects on length of stay in the ICU, length of hospital stay, duration of renal replacement therapy or duration of mechanical ventilation. The outcomes of resuscitation with albumin and saline are similar irrespective of patients' baseline serum albumin concentration.
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We present here a technique to mitigate the complication of multiple needle entries into the thecal sac when attempting to place an intrathecal catheter into the thecal sac. Our technique of injecting radio-opaque contrast material after entering the epidural space and before entering the thecal sac allows for visualization of the thecal sac within the spinal canal, thus obviating the technique of "fell and pop" to enter the sac. In our hands, this technique has improved outcomes for our patients and has decreased the incidence of post dural puncture headache, neural trauma and technical failures.
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Background. Spinal cord stimulation (SCS) is effective in reducing pain from a number of differing medical conditions that are refractory to other, more conservative treatments. Much is written in the literature regarding efficacy and safety of SCS; however, no one to our knowledge has compared and reported safety and efficacy of SCS when using differing manufactured SCS devices. We undertook such a preliminary evaluation. ⋯ Conclusions. Spinal cord stimulation improves pain, sleep, and function in patients with intractable pain. Because of the low number of patients evaluable in this study, we believe that conclusions should not be made regarding the effect of technology on outcomes or safety. We believe that an analysis of this type in larger populations is warranted to understand the role, if any, that present-day technology has on outcomes of SCS.
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Objectives. Spinal cord stimulation has been used extensively for failed back surgery syndrome, although dominant axial low back pain is difficult to treat effectively with this modality. The use of a surgically placed, double, quadripolar lead may result in better paresthesia of the low back, therefore enhancing outcomes in this difficult to treat population. Materials and Methods. Accordingly, this prospective study was designed to assess the effectiveness of placing such a lead at the T8-T10 level under general anesthesia without intraoperative testing for concordancy of paresthesia distribution. ⋯ The ability to lead a more active and social life was increased and 85% of patients said they would undergo spinal cord stimulation again. Placing the lead higher in the spinal canal (T8) resulted in a tendency for better paresthesia coverage of the low back when compared to lower lead placements. Conclusions. Placing a double quadripolar paddle lead under general anesthesia resulted in good clinical outcome similar to other implant techniques.
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Mortality rates in the Intensive Care Unit and subsequent hospital mortality rates in the UK remain high. Infections in Intensive Care are associated with a 2-3 times increased risk of death. It is thought that under conditions of severe metabolic stress glutamine becomes "conditionally essential". Selenium is an essential trace element that has antioxidant and anti-inflammatory properties. Approximately 23% of patients in Intensive Care require parenteral nutrition and glutamine and selenium are either absent or present in low amounts. Both glutamine and selenium have the potential to influence the immune system through independent biochemical pathways. Systematic reviews suggest that supplementing parenteral nutrition in critical illness with glutamine or selenium may reduce infections and mortality. Pilot data has shown that more than 50% of participants developed infections, typically resistant organisms. We are powered to show definitively whether supplementation of PN with either glutamine or selenium is effective at reducing new infections in critically ill patients. ⋯ To date more than 285 patients have been recruited to the trial from 10 sites in Scotland. Recruitment is due to finish in August 2008 with a further six months follow up. We expect to report the results of the trial in summer 2009.