Crit Care Resusc
-
Case Reports Comparative Study
Comparison of intermittent haemodialysis, prolonged intermittent renal replacement therapy and continuous renal replacement haemofiltration for lithium toxicity: a case report.
This case report compares three types of renal replacement therapy for acute severe lithium toxicity and is the first to use prolonged intermittent renal replacement therapy (PIRRT). A peak lithium level of 13.2mmol/L was recorded after a 51- year-old man attempted suicide. ⋯ Expected efficacy of treatment with a single daily session of PIRRT was higher than IHD or CVVH. PIRRT is a useful strategy for dialysis among patients with acute lithium intoxication.
-
Comparative Study
Calcium flux in continuous venovenous haemodiafiltration with heparin and citrate anticoagulation.
Calcium chelation with citrate is an effective alternative to heparin for anticoagulation of the extracorporeal circuit during continuous venovenous haemodiafiltration (CVVHD-F). Calcium release occurs upon citrate metabolism; however, ultrafiltration of citrate-bound and free ions also occurs. ⋯ Despite supplementation to maintain arterial iCa(2+) levels, citrate anticoagulation results in a net calcium deficit. An equation for estimating required citrate dose may allow revision of citrate dosing protocols.
-
Multicenter Study Comparative Study Clinical Trial
Fever and fever management among intensive care patients with known or suspected infection: a multicentre prospective cohort study.
To describe the duration of fever, fever management, and outcomes among intensive care patients with fever and known or suspected infection. ⋯ We have described the typical time course of fever in an easily identified cohort of patients with known or suspected infection and have determined that these patients have significant morbidity and mortality. This information is vital to the design of interventional studies for the treatment of fever in ICU.
-
Review Meta Analysis
The effect of antipyretic medications on mortality in critically ill patients with infection: a systematic review and meta-analysis.
Antipyretic medications are widely used in critically ill patients with infection despite evidence supporting a protective, adaptive role of fever. ⋯ The studies included in this review were insufficient to allow a robust estimate of the effect of pharmacological antipyresis on mortality in critically ill patients with suspected infection. Further RCTs are required to resolve this important area of clinical uncertainty.
-
Comparative Study
Bedside electronic capture of clinical observations and automated clinical alerts to improve compliance with an Early Warning Score protocol.
Failure to comply with clinical protocols and failure of communication to ensure delivery of the most appropriate timely clinical responses to patients whose conditions are acutely deteriorating have been shown to be significant causative factors associated with inhospital adverse events. ⋯ Electronic recording of patient observations linked to a computer system that calculates patient risk and then issues automatic graded alerts can improve clinical attendance to unstable general medical ward patients.