Crit Care Resusc
-
Randomized Controlled Trial
Comparison of normal or heparinised saline flushing on function of arterial lines.
Heparin is used as a flush solution for intravenous and intra-arterial lines, but has a number of drug interactions, as well as potentially serious side effects. ⋯ Heparin as a continuous flush at 3 units/hour does not improve the function of arterial lines compared with a continuous normal-saline flush.
-
To measure functional outcome of long-stay intensive care unit patients in the Australian population. ⋯ Of 68 long-stay ICU patients, an average of 2 years after discharge, 50% were alive, including 25% living normal active lives. The remaining 25% described some disability. In most cases (88%), this was mild: only two patients (3% of the total group) depended on daily support. No patients were left in a persistent vegetative state.
-
Case Reports
Severe pneumonia with pneumatoceles and patent foramen ovale in an infant: optimal ventilation strategy?
We discuss a case of severe pneumonia with pneumatoceles in a 2-month old infant. Despite peak and plateau airway pressures kept below 30 and 25 cmH(2)O, respectively, the infant developed bilateral pneumothorax and pneumomediastinum caused by pneumatocele rupture, necessitating bilateral intercostal drainage. Application of positive end-expiratory pressure (PEEP) of 10 cmH(2)O at FIO(2) of 0.7 worsened oxygenation, and transthoracic echocardiography showed right-to-left shunting of blood through the patent foramen ovale. ⋯ The open lung strategy of higher increments of PEEP and lower FIO(2) for lung protective ventilation actually proved deleterious to our patient. We conclude that a subset of patients with acute respiratory distress syndrome with refractory hypoxaemia may have right-to-left shunting of blood through a patent foramen ovale. This can be detected by echocardiography, and these patients may benefit from a ventilation strategy aimed at lowering pulmonary vascular resistance.
-
Comment Letter Biography Historical Article
History of mouth-to-mouth rescue breathing: some matters concerning John and Anthony Fothergill.