Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Hemorrhage is the leading cause of pediatric death in trauma and cardiac arrest during surgery. Adult studies report improved patient outcomes using massive hemorrhage protocols (MHPs). Little is known about pediatric MHP adoption in Canada. ⋯ Pediatric MHP content was highly variable. Activation demographics suggest underuse in nontrauma settings. Our findings highlight the need for a consensus definition for pediatric massive hemorrhage, a validated pediatric MHP activation tool, and prospective assessment of blood component ratios. A national pediatric MHP activation repository would allow for quality improvement metrics.
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Observational Study
Exposure levels and target attainment of piperacillin/tazobactam in adult patients admitted to the intensive care unit: a prospective observational study.
The objective of this study was to evaluate the exposure and the pharmacodynamic target attainment of piperacillin/tazobactam (PTZ) in adult critically ill patients. ⋯ In this prospective observational study of adult ICU patients receiving intravenous PTZ, a large proportion had subtherapeutic concentrations of piperacillin. This was most notable in patients with normal to augmented renal clearance. More aggressive dosage regimens may be required for this subpopulation to ensure attainment of efficacy targets.
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Randomized Controlled Trial
Inhaled iloprost in off-pump coronary artery bypass surgery: a randomized controlled trial.
Mechanical cardiac constraint during off-pump coronary artery bypass surgery (OPCAB) causes right ventricle (RV) compression and increased pulmonary artery pressure (PAP), which may further compromise RV dysfunction. We aimed to assess the effect of inhaled iloprost, a potent selective pulmonary vasodilator, on the cardiac index (CI) during mechanical constraint. The secondary aim was to determine the resultant changes in the hemodynamic and respiratory parameters. ⋯ Inhaled iloprost showed a neutral effect on hemodynamic parameters, including the CI and pulmonary vascular resistance index, during OPCAB.
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Disruptive intraoperative behaviour can have detrimental consequences for clinicians, institutions, and patients. The way victims and witnesses respond to disruptive behaviour can ameliorate or exacerbate consequences. Nevertheless, previous research has neither described the responses of a multinational sample of clinicians nor developed tools to recognize and evaluate responses. ⋯ The responses of thousands of clinicians involved passivity, manipulativeness, or maliciousness. We present norms and a response pattern classification to help organizations evaluate responses, recognize response patterns, and provide tailored support to victims and witnesses.