Crit Care Resusc
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To investigate the prevalence and clinical significance of upper gastrointestinal (UGI) findings during endoscopic placement of postpyloric feeding tubes in intensive care patients. ⋯ Endoscopic placement of postpyloric feeding tubes resulted in the identification of a significant number of patients with previously undiagnosed UGI abnormalities.
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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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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.
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Extracorporeal life support (ECLS) is a lifesaving technology that is being increasingly used in patients with severe cardiorespiratory failure. However, ECLS is not without risks. The biosynthetic interface between the patient and the circuit can significantly alter inflammation, coagulation, pharmacokinetics and disposition of trace elements. The relative contributions of the pump, disease and patient in propagating these alterations are difficult to quantify in critically ill patients with multiple organ failure. ⋯ The establishment of in-vitro and in-vivo models provides a powerful means for enhancing knowledge of the pathophysiology associated with ECLS and identification of key factors likely to influence patient outcomes. A clearer description of the contribution of disease and therapeutic interventions may allow improved design of equipment, membranes, medicines and physiological goals for improved patient care.