Resuscitation
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Randomized Controlled Trial Comparative Study
Evaluation of a novel paediatric self-inflating bag to improve accuracy of tidal volumes delivered during simulated advanced paediatric resuscitation.
The aim of the study is to compare the accuracy of manually delivered target tidal volumes (TVs) with the conventional paediatric self-inflating bags (CPBs) versus the novel paediatric self-inflating bags (NPBs) during simulated advanced paediatric resuscitation. ⋯ NPB is useful as a ventilation device for the accurate delivery of TV to small children of varying weights.
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Randomized Controlled Trial Comparative Study
Quality controlled manual chest compressions and cerebral oxygenation during in-hospital cardiac arrest.
The quality of cardiopulmonary resuscitation (CPR) is associated with the rate of return of spontaneous circulation (ROSC) during human cardiac arrest. Current advances in defibrillator technology enable measurement of CPR quality during resuscitation, but it is not known whether this is directly reflected in cerebral oxygenation. In this descriptive study we aimed to evaluate whether the quality of feedback-monitored CPR during in-hospital cardiac arrest is reflected in near infrared frontal cerebral spectroscopy (NIRS). ⋯ High quality CPR was not significantly reflected in cerebral oxygenation as quantified using NIRS. Even after ROSC and subsequent significant increase in cerebral oxygenation, rSO(2) readings were below previously suggested threshold of cerebral ischaemia. Improving CPR technique after an episode of low quality CPR did not significantly increase rSO(2).
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To investigate the association between regional brain oxygen saturation (rSO(2)) on hospital arrival and neurological outcomes at hospital discharge in patients with out-of-hospital cardiac arrest (OHCA). ⋯ rSO(2) on hospital arrival may help predict neurological outcomes at hospital discharge in patients with OHCA.
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Comparative Study
What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population?
To describe the relationship of gag and cough reflexes to Glasgow coma score (GCS) in Chinese adults requiring critical care. ⋯ Our study has shown that in a Chinese population with a wide range of critical illness (but little trauma or intoxication), reduced GCS is significantly related to gag and cough reflexes. However, a considerable proportion of patients with a GCS≤8 have intact airway reflexes and may be capable of maintaining their own airway, whilst many patients with a GCS>8 have impaired airway reflexes and may be at risk of aspiration. This has important implications for airway management decisions.
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Successful resuscitation after cardiac arrest is typically associated with cerebral and myocardial ischemia/reperfusion (I/R)-injury. Recently, we have demonstrated effects of therapeutic hypothermia (HT) and postconditioning with the volatile anesthetic sevoflurane (SEV) on I/R-mediated mechanisms in the heart and brain [Meybohm et al., PLoS One, 2009; Meybohm et al., Crit Care, 2010]. As the intestine is also highly susceptible to I/R-injury, we investigated the influence of HT and SEV on intestinal I/R-mediated events induced by cardiac arrest and successful resuscitation. ⋯ HT and postconditioning with SEV influence the expression and activity of several small intestinal proteins that are possibly involved in intestinal I/R-mediated events following successful cardiopulmonary resuscitation.