Crit Care Resusc
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Randomized Controlled Trial Multicenter Study
Angiotensin II for the Treatment of High-Output Shock 3 (ATHOS-3): protocol for a phase III, double-blind, randomised controlled trial.
Catecholamine-resistant hypotension (CRH) is characterised by inadequate response to standard doses of vasopressors, and increased mortality. Our Angiotensin II for the Treatment of High-Output Shock 3 (ATHOS-3) trial compares the efficacy and safety of angiotensin II (ANGII) versus placebo in CRH. ⋯ Our study will investigate the utility of adding ANGII to current SOC vasopressor options to increase the efficacy and safety of CRH therapy.
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Pleural effusion adversely affects the pressuregenerating capacity of the diaphragm. It uncouples the lung and chest wall, which may result in diaphragmatic dysfunction. Information on the effects of effusion drainage on diaphragmatic function is limited, but several studies report relief of dyspnoea after drainage, which was attributed to improved diaphragmatic mechanics, even if this issue was never formally addressed. ⋯ Drainage of a unilateral pleural effusion during weaning from mechanical ventilation improves diaphragmatic contractile activity and respiratory system performance.
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To describe the frequency and hospital mortality of problems (diagnoses) encountered by a rapid response team (RRT), and to identify the most common diagnoses for RRT triggers and for treating units. ⋯ The RRT activation trigger provides only a general indication of the diagnosis. Some problems appear preventable and could provide a focus for unit-based quality initiatives. The mortality of some diagnoses is substantial, and this may help in setting treatment goals, but more work is needed to understand the association of RRT diagnosis and outcome.
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Observational Study
Longitudinal changes in anthropometrics and impact on self-reported physical function after traumatic brain injury.
Patients admitted to the ICU with a traumatic brain injury (TBI) are at risk of muscle wasting but this has not been quantified. Our aims were to describe longitudinal changes in anthropometrical data, compare the accuracy of non-invasive methodologies to the validated dual-energy x-ray absorptiometry (DXA), and assess the relationships between anthropometrical data and self-reported physical function. ⋯ Patients with a TBI lose muscle thickness while in the ICU but the trajectory of loss stabilises after ICU discharge. Ultrasound-derived QMLT is related to total lean mass and physical function after discharge. Further studies are needed to confirm that ultrasound measurement of QMLT is a useful surrogate measure of muscle mass and functional outcomes after trauma and critical illness.
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To investigate the frequency, characteristics and timing of objectively measured clinical instability in adult ward patients in the 24 hours preceding activation of the medical emergency team (MET). We also examined ward clinician responses to documented clinical instability. ⋯ Patients commonly and repeatedly breached objectively measured UCR criteria in the 24 hours preceding MET activation, providing numerous opportunities for clinicians to recognise and respond to early clinical deterioration. The high incidence of pre- MET afferent limb failure requires further exploration.