Journal of critical care
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Journal of critical care · Mar 2010
Insight in microcirculation and histomorphology during burn shock treatment using in vivo confocal-laser-scanning microscopy.
Microcirculatory disturbances are well known during shock; however, the accompanied histomorphological alterations are widely unknown. We used high resolution confocal-laser-scanning microscopy for the evaluation of microcirculation and histomorphology during Burn Shock treatment. ⋯ Confocal-laser-scanning microscopy provides a noninvasive tool for simultaneous evaluation of microcirculation and tissue histomorphology. It may help to assess the adequacy of and response to resuscitation of burn patients early after trauma.
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Journal of critical care · Mar 2010
ReviewBest interests at end of life: a review of decisions made by the Consent and Capacity Board of Ontario.
When patients are unable to communicate their own wishes, surrogates are commonly used to aid in decision making. Although each jurisdiction has its own rules or legislation governing how surrogates are to make health care decisions, many rely on the notion of "best interests" when no prior expressed wishes are known. ⋯ Several lessons are drawn for the benefit of health care teams engaged in end-of-life conflicts with substitute decision makers over the best interests of patients.
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Journal of critical care · Mar 2010
Comparative Study Clinical TrialMetabolic effects of citrate- vs bicarbonate-based substitution fluid in continuous venovenous hemofiltration: a prospective sequential cohort study.
Studies investigating the metabolic effects of citrate-based substitution fluids are lacking. This study aims to compare the effect of citrate- vs bicarbonate-based substitution fluid used during continuous venovenous hemofiltration (CVVH) for acute kidney injury on acid-base balance and electrolytes in critically ill patients. ⋯ Citrate-based substitution fluid is comparable to bicarbonate-based substitution fluid during CVVH in critically ill patients with acute kidney injury, concerning acid-base balance and electrolyte control. This implies complete conversion of citrate to bicarbonate in the patients studied.
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Journal of critical care · Mar 2010
Randomized Controlled Trial Comparative StudyA carbohydrate-restrictive strategy is safer and as efficient as intensive insulin therapy in critically ill patients.
The aim of this study is to compare the safety and efficacy of 2 different strategies for glycemic control in critically ill adult patients. ⋯ A carbohydrate-restrictive strategy reduced significantly the incidence of hypoglycemia in critically ill patients compared to intensive insulin therapy. Mortality and morbidity were comparable between the 2 groups.