Crit Care Resusc
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Multicenter Study Observational Study
Nutrition therapy in adult patients receiving extracorporeal membrane oxygenation: a prospective, multicentre, observational study.
To describe current nutrition delivery practices and to identify barriers to nutrition in patients receiving venovenous or venoarterial extracorporeal membrane oxygenation (ECMO) in multiple centres in Australia and New Zealand. ⋯ EN was the most commonly used nutrition-delivery mode during ECMO treatment but was frequently interrupted. Compared with estimated calorie and protein requirements, lesser but reasonably acceptable amounts were delivered, although calorie and protein deficits still existed.
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To assess the prevalence of patients fulfilling clinical review criteria (CRC), to determine activation rates for CRC assessments, to compare baseline characteristics and outcomes of patients who fulfilled CRC with patients who did not, and to identify the documented nursing actions in response to CRC values. ⋯ About one in five patients reached CRC during the study period; these patients were about four times more likely to also fulfil MET call criteria. Contrary to hospital policy, escalation was not documented for about half the patients meeting CRC values. Despite the clarity of escalation procedures on the graphic observation chart, escalation remains an ongoing problem. Further research is needed on the impact on patient outcomes over time and to understand factors influencing staff response.
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Variations in blood glucose (BG), hyperglycaemia and hypoglycaemia are associated with adverse clinical outcomes in intensive care unit patients. Continuous glucose monitoring (CGM) offers the potential to improve BG control, leading to improved patient outcomes. In our product development study, we determined the safety and performance of the GluCath Intravascular CGM System for up to 48 hours in 20 patients admitted to the ICU after cardiac surgery. ⋯ The GluCath system, using quenched fluorescence sensing, was safe and showed acceptable accuracy when deployed for up to 48 hours in ICU patients after elective cardiac surgery.
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We hypothesise that there exists a substantial and growing group of "persistently critically ill" patients who appear to be intensive care unit-dependent because of a cascade of critical illnesses rather than their original ICU admitting diagnosis. These persistently critically ill patients are those who remain in the ICU because of ongoing complications of care that continue after their reason for admission has been treated and is no longer active. ⋯ We further believe that their primary problem is not simply failure to wean from mechanical ventilation due to muscle weakness and impaired gas exchange. We outline a program of clinician consultation, epidemiological research, consensus conference and validation to develop a useful definition of persistent critical illness, with the aim of supporting investigations in preventing persistence, and improving the care of patients so affected.
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Observational Study
Initial levels of organ failure, microbial findings and mortality in intensive care-treated primary, secondary and tertiary sepsis.
Analysis of whether patients with primary, secondary and tertiary sepsis, defined by the presence or absence of recent systemic inflammation-inducing events before the onset of sepsis, differ in clinical presentation, microbiological test results, treatment received and outcome. ⋯ Inflammatory insults before the onset of sepsis affect the clinical picture, blood microbial findings, and in non-survivors, the time of death. These results could, if validated in a prospective study, form a basis for a novel and simple strategy for stratifying patients in clinical studies for immunomodulation therapies in sepsis.