Crit Care Resusc
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Randomized Controlled Trial
Effect of midazolam versus propofol sedation on markers of neurological injury and outcome after isolated severe head injury: a pilot study.
Midazolam and propofol are sedative agents commonly administered to patients with brain injury. We compared plasma concentrations of glial cell S100beta protein and nitric oxide (NO) between patients who received midazolam and those who received propofol sedation after severe brain injury, and investigated the association between S100beta and NO concentrations and neurological outcome. ⋯ Plasma concentrations of markers of neurological injury in patients with severe head injury were similar in those who received midazolam sedation and those who received propofol. Patients who had a poor neurological outcome at 3 months had consistently higher serum S100beta concentrations during the initial 4 days after injury than patients who had a good outcome.
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Withdrawal of potentially life-prolonging treatments is a common procedure in most intensive care units. Until recently, quality improvement activities have been hampered by the absence of a clear sense of "best practice" in this complex area. ⋯ A current ICU quality improvement review lists EOL management as a possible audit item (Curtis et al. Crit Care Med 2006; 34: 211). Our study demonstrated the feasibility of developing a quality improvement tool for EOL decision-making and applying it in the intensive care setting. As evidence about the process of EOL decisionmaking accumulates, that process should become a component of quality assurance audit in intensive care.
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Historical Article
History of mouth-to-mouth ventilation. Part 3: the 19th to mid-20th centuries and "rediscovery".
The start of the 19th century saw the enthusiasm of the previous one for mouth-to-mouth ventilation (MMV) dissipated. To inflate the lungs of the asphyxiated, the Royal Humane Society in the United Kingdom had recommended bellows since 1782. Principal determinants for change were aesthetic distaste for mouth-to-mouth contact and the perceived danger of using expired air, although MMV survived in the practice of some midwives. ⋯ Ready adoption of MMV in the US was followed by worldwide spread, especially after endorsement from the 1962 international symposium at Stavanger in Norway. However, already there were occasional rumblings of reluctance to perform MMV. In this article, I consider MMV also in the context of other ventilatory modes for resuscitation.
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Over the past 12 years, the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group and the broader intensive care community in Australia and New Zealand have established a track record for conducting high quality, investigator-initiated clinical research in critically ill patients. This is highlighted by the publication of the SAFE (Saline Albumin Fluid Evaluation) study in the New England Journal of Medicine and the MERIT (Medical Early Response Intervention and Therapy) study in the Lancet. Here, we discuss potential impediments to the further advancement of intensive care research in Australia and New Zealand, and suggest strategies to address them. ⋯ We contend that the best chance of improving outcomes in many disease states requires studies to commence before patients enter the ICU, which will depend on collaboration with established and emerging craft groups, such as ambulance services, emergency medicine and anaesthesia. We also emphasise the need to study system factors affecting patient outcomes, as well as the translation of research findings into clinical practice. Finally, we describe the establishment and objectives of the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) and outline the Centre's current projects in the context of an integrated research framework.