Crit Care Resusc
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Randomized Controlled Trial Multicenter Study Comparative Study
Statistical analysis plan for the Crystalloid Versus Hydroxyethyl Starch Trial (CHEST).
The Crystalloid Versus Hydroxyethyl Starch Trial (CHEST) is a 7000-patient, multicentre, randomised controlled trial comparing the effects of 6% hydroxyethyl starch (130/0.4) to normal saline for fluid resuscitation in intensive care patients. The trial design is based on the Saline Versus Albumin Fluid Evaluation (SAFE) study and will be the largest fluid resuscitation trial conducted to date. ⋯ We have developed a predetermined SAP for CHEST. This plan accords with high-quality standards of internal validity to minimise analysis bias.
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Randomized Controlled Trial
Increased brain tissue oxygen tension in children with traumatic brain injury using temperature-corrected guided ventilation during prophylactic hypothermia.
To investigate whether ventilatory management using a temperature-corrected (pH-stat) or uncorrected (alpha-stat) blood gas analysis strategy improves brain tissue oxygen tension (PbrO(2)) in children prophylactically treated with moderate hypothermia for traumatic brain injury. ⋯ PbrO(2) may be improved using a pH-stat blood gas management strategy in prophylactic hypothermia for paediatric patients with traumatic brain injury without any clinically relevant increase in ICP.
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We describe a case of a 51-year-old man who ingested methylene chloride and presented with the classical clinical features. He developed an acute abdomen that required repeated laparotomy. The effect of an ethanol infusion on carboxyhaemoglobin concentrations in this case was also of interest and could potentially be a new treatment modality.
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Comparative Study
Relationship between illness severity scores in acute kidney injury.
In the field of critical care nephrology, recent publications have used different illness severity scoring systems, making outcome comparisons difficult. ⋯ Simple, robust translational formulae can be developed to allow clinicians to compare illness severity of patients with AKI when illness severity is expressed with different scoring systems.
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Case Reports
Two cases of toxic methanol ingestion, one leading to brain death: case reports and a brief review.
Two patients were admitted sequentially to a rural emergency department, then transferred to a tertiary intensive care unit, both with serious methanol poisoning from home-brewed alcohol. They were intubated, mechanically ventilated, and treated with intravenous and nasogastric ethanol and continuous venovenous haemodiafiltration. Although quite similar in presentation, metabolic complications and therapy, one patient became brain dead due to severe cerebral oedema, while the other was discharged without any significant complications. Their course highlights the importance of early treatment of non-ethanol alcohol poisoning.