Critical care : the official journal of the Critical Care Forum
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Comparative Study
Minimal instructions improve the performance of laypersons in the use of semiautomatic and automatic external defibrillators.
There is evidence that use of automated external defibrillators (AEDs) by laypersons improves rates of survival from cardiac arrest, but there is no consensus on the optimal content and duration of training for this purpose. In this study we examined the use of semiautomatic or automatic AEDs by laypersons who had received no training (intuitive use) and the effects of minimal general theoretical instructions on their performance. ⋯ Untrained laypersons can use semiautomatic and automatic AEDs sufficiently quickly and without instruction. After one use and minimal instructions, improvements in practical performance were significant. All tested laypersons were able to deliver the first shock in under 1 min.
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Case Reports Comparative Study
Myoglobin clearance by super high-flux hemofiltration in a case of severe rhabdomyolysis: a case report.
To test the ability of a novel super high-flux (SHF) membrane with a larger pore size to clear myoglobin from serum. ⋯ SHF hemofiltration achieved a much greater clearance of myoglobin than conventional hemofiltration, and it may provide a potential modality for the treatment of myoglobinuric acute renal failure.
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Comparative Study
Serum cystatin C concentration as a marker of acute renal dysfunction in critically ill patients.
In critically ill patients sudden changes in glomerular filtration rate (GFR) are not instantly followed by parallel changes in serum creatinine. The aim of the present study was to analyze the utility of serum cystatin C as a marker of renal function in these patients. ⋯ Cystatin C is an accurate marker of subtle changes in GFR, and it may be superior to creatinine when assessing this parameter in clinical practice in critically ill patients.
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The use of a nursing-directed and/or respiratory therapist-directed protocol in many intensive care units for weaning from mechanical ventilation is associated with a shorter duration of ventilation and length of stay in the ICU. Most protocols have two formal components: the daily screening of a set of simple observations or interventions to identify readiness to proceed, followed by a spontaneous breathing trial that tests the patient's ability to breathe independently. The daily screen is designed to identify potential barriers regarding medical stability, level of consciousness, oxygenation, ventilation, and airway patency and protection. However, one must avoid selecting criteria that are too restrictive, potentially delaying the discontinuation of ventilation.
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Comment Comparative Study
Extracorporeal therapies in acute rhabdomyolysis and myoglobin clearance.
Rhabdomyolysis is a pathogenetic cause of acute kidney injury. In such circumstances, not only should therapeutic strategies to replace the failing kidney be implemented, but measures should also be explored to prevent further damage by circulating myoglobin. Volume expansion and forced diuresis have been used, but when a kidney fails, renal replacement therapies are instituted. ⋯ The removal of myoglobin was greater than in than any previous report. Thus, if the removal of myoglobin is desirable, a combination of continuous hemofiltration and hyperpermeable membranes seems to be the most effective. However, care must be exercised to prevent unwanted albumin losses.