Critical care : the official journal of the Critical Care Forum
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SARS (severe acute respiratory syndrome) proved an enormous physical and emotional challenge to frontline health care workers throughout the world in late 2002 through to mid 2003. A large percentage of patients (many being health care workers themselves) became critically ill. Unfortunately, clinicians caring for these individuals did not have the advantage of previous experience or research data on which to base treatment decisions. ⋯ In many centres systemic steroids, which carry many potential downsides, became a mainstay of therapy. In this issue of Critical Care, two groups that have frontline experience of SARS debate the role of steroids. Let us hope and pray together that we never have the patient population needed to resolve the questions the two sides raise.
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This new section in Critical Care presents a selection of clinically important examples of advances in critical care health technology. This article is divided into two main areas: diagnostics and monitoring. Attention is given to how bedside echocardiography can alter the cardiovascular physical examination, and to novel imaging techniques such as virtual bronchoscopy. The monitoring section discusses recent claims of improved efficiency with telemedicine for intensive care units.
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Acid-base disorders are common in critically ill patients. Metabolic acid-base disorders are particularly common in patients who require acute renal replacement therapy. In these patients, metabolic acidosis is common and multifactorial in origin. ⋯ The nature and extent of these acid-base changes is governed by the intensity of plasma water exchange/dialysis and by the 'buffer' content of the replacement fluid/dialysate, with different effects depending on whether lactate, acetate, citrate, or bicarbonate is used. These effects can be achieved in any patient irrespective of whether they have acute renal failure, because of the overwhelming effect of plasma water exchange on nonvolatile acid balance. Critical care physicians must understand the nature, origin, and magnitude of alterations in acid-base status seen with acute renal failure and during continuous hemofiltration if they wish to provide their patients with safe and effective care.
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Comparative Study
Quality of life of survivors from severe sepsis and septic shock may be similar to that of others who survive critical illness.
The objective of the present study was to compare the health-related quality of life (HR-QoL) of survivors from severe sepsis and septic shock with HR-QoL in others who survived critical illness not involving sepsis. ⋯ Evaluation using the EQ-5D at 6 months after ICU discharge indicated that survivors from severe sepsis and septic shock have a similar HR-QoL to that of survivors from critical illness admitted without sepsis.
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This report describes the case mix, outcome and activity (duration of intensive care unit [ICU] and hospital stay, inter-hospital transfer, and readmissions to the ICU) for admissions to ICUs for acute severe asthma, and investigates the effect of case mix factors on outcome. ⋯ ICU admission for asthma is relatively uncommon but remains associated with appreciable in-hospital mortality. The greatest determinant of poor hospital survival in asthma patients was receipt of CPR within 24 hours before admission to ICU. Clinical management of these patients should be directed at preventing cardiac arrest before admission.