Crit Care Resusc
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To assess the frequency of after-hours discharges of patients from the intensive care unit and its effect on in-hospital mortality. ⋯ A high proportion of patients (34.7%) were discharged from the ICU after-hours. Discharge after-hours was associated with a higher risk of in-hospital mortality than discharge during work hours.
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Metformin, a widely used hypoglycaemic agent in type 2 diabetes mellitus, is uncommonly associated with lactic acidosis, a serious condition with high mortality. ⋯ MALA is a not uncommon cause of ICU admission. Gastrointestinal symptoms predominate in MALA, and the condition is associated with significant morbidity and mortality.
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To evaluate antibiotic prescribing practices in empirical and directed treatment of severe sepsis and septic shock in Australian and New Zealand intensive care units. ⋯ Antibiotic prescribing was largely appropriate, but consideration of site-specific resistance profiles and avoidance of low dosing is advocated to provide appropriate upfront cover, prevent underdosing and reduce the risk of developing resistant organisms.
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Infusion of propofol often causes significant vasodilation, which is followed by a profound drop in blood pressure. However, the exact underlying molecular mechanisms of this clinically important phenomenon remain unclear. ⋯ Development of hypotension after systemic administration of propofol is mainly caused by its direct relaxation effect on vascular smooth muscle. This response is mainly mediated by activation of K(ATP) channels.
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Unplanned admission to the intensive care unit has been shown to significantly increase the risk of inhospital mortality. Medical advances and increased expectations have resulted in a greater number of very elderly patients (80 years and over) being admitted to the ICU. The risk of in-hospital death associated with unplanned admission to the ICU in very elderly patients has not been clearly defined. ⋯ Unplanned admission to the ICU increases the risk of in-hospital mortality in very elderly patients. At least 50% of the risk of in-hospital death in this age group is attributable to a combination of unplanned ICU admission, comorbidity (≥1 comorbid condition), acute renal failure and respiratory failure.