Crit Care Resusc
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Comparative Study Clinical Trial
Near-infrared spectroscopy of the thenar eminence: comparison of dynamic testing protocols.
Near-infrared spectroscopy of the thenar eminence (NIRSth) is a non-invasive bedside method for assessing tissue oxygenation. The vascular occlusion test (VOT) with a pressure cuff can be used to provide a dynamic assessment of the tissue oxygenation response to ischaemia. VOT has been applied to assess the microcirculation by NIRSth in critically ill patients. The optimal mode of performing such VOT, however, remains controversial. ⋯ The 3-minute VOT and the 40% StO(2) appear equivalent. However, the 3-minute VOT carries a degree of decreased patient discomfort and shorter overall duration of execution.
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Multicenter Study
Enteral nutrition in Australian and New Zealand intensive care units: a point-prevalence study of prescription practices.
Enteral nutrition (EN) is widely accepted as the preferred method for providing nutrition therapy to critically ill patients. However, optimal energy goals and the best way to achieve those goals are ill defined. ⋯ 1 kcal/mL and energy-dense formulations are administered with about equal frequency in Australian and New Zealand ICUs. This finding supports future research into the evaluation of optimal nutritional delivery amounts using EN formulations with differing energy concentrations.
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To determine the accuracy of International classification of diseases, 10th revision, Australian modification (ICD-10-AM) codes in identifying severe sepsis in patients admitted from the emergency department (ED). ⋯ ICD-10-AM codes recorded in the EDIS or HMD had limited utility for identifying severe sepsis in patients admitted to ICU from the ED.
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Comparative Study
Comparison of automated and static pulse respiratory mechanics during supported ventilation.
To compare respiratory mechanics estimated by the (pulse) technique in spontaneously breathing patients during proportional assist ventilation (PAV) with load-adjustable gain factor (PAV+) mode with those measured using the flow-interruption technique during controlled ventilation. ⋯ Based on these data, respiratory mechanics estimated from the (pulse) technique are too inaccurate to be clinically useful.
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We established an adult extracorporeal membrane oxygenation (ECMO) service for cardiorespiratory support in April 2009. Complex therapies may show a learning curve and volume-outcome relationship. ⋯ Satisfactory outcomes were achieved using an ICU-based multidisciplinary approach with a broadly based education strategy with additional clinical perfusionist support to manage the learning curve.