Crit Care Resusc
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Editorial Comment
Why predict time to death after withdrawal of life-sustaining therapy?
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To determine the effect an intensive care unit liaison nurse service had on ICU patient discharges, readmissions and outcomes. ⋯ The introduction of our ICU liaison nurse service was associated with a trend towards more efficient ICU discharges (increased throughput, decreased ICU step-down days and ICU readmission LOS) and improved survival for ICU patients requiring readmission, but overall ICU and hospital LOS and mortality, and ICU readmission rates were unchanged.
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Randomized Controlled Trial
Pilot randomised double-blind controlled trial of high-dose spironolactone in critically ill patients receiving a frusemide infusion.
Hypernatraemia may develop during intravenous infusion of frusemide. Spironolactone is an aldosterone antagonist that promotes natriuresis and may attenuate such hypernatraemia, but its effect in this setting has not been previously studied. ⋯ In this pilot study, the administration of high-dose spironolactone to ventilated critically ill patients receiving frusemide by infusion had no significant effects on serum sodium level, natriuresis or potassium balance when compared with placebo.
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Multicenter Study
Prediction of death after withdrawal of life-sustaining treatments.
To assess the predictive value of respiratory and haemodynamic variables and opinion of the intensivist for determining how soon death occurs after withdrawal of life-sustaining treatments (WLST). ⋯ It is possible to predict the time from WLST to death accurately using a tool that combines GCS, respiratory and haemodynamic parameters and intensivist opinion. These results require validation in a large multicentre study.
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Review
Restrictive red blood cell transfusion strategies in critical care: does one size really fit all?
Many intensive care patients receive red blood cell transfusions. International clinical practice has recently changed, with a decrease in the "trigger" haemoglobin concentration used for red blood cell transfusions in critically ill patients. This change has been driven by increasing awareness of the infectious and non-infectious complications of allogeneic red blood cell transfusion, the perennial blood supply shortages, and most importantly by the Transfusion Requirements in Critical Care (TRICC) study, which suggested that a restrictive transfusion strategy (a transfusion trigger of 70 g/L and a post-transfusion goal of 70-90 g/L) may be equivalent to a liberal transfusion strategy (a transfusion trigger of 100 g/L and a posttransfusion goal of 100-120 g/L) in non-shocked ICU patients. ⋯ Despite this, and a number of important methodological issues that limit the generalisation of the TRICC results to patients with ischaemic heart disease, the TRICC authors, subsequent guidelines and recent reviews have recommended a restrictive strategy in ICU patients with ischaemic heart disease. This conclusion and the change in clinical practice that followed these publications are premature. In determining the appropriate trigger for transfusion of allogeneic blood, the physician should ideally weigh the risk-benefit profile for each individual patient, for each unit of blood administered.