Articles: outcome.
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The use of automated external defibrillators (AEDs) following a cardiac arrest in the out-of-hospital setting has demonstrated increased survival rates, likely because up to 71% of out-of-hospital cardiac arrests are associated with rhythm disturbances that are able to be treated with defibrillation. It is less clear whether the use of AEDs in the hospital setting would be effective because fewer patients (approximately 25%) have initial cardiac rhythms that respond to defibrillation and because survival may be compromised if the use of AEDs contributes to interruptions in the delivery of chest compressions. ⋯ Of the 11,695 patients with cardiac arrests, the majority (82.2%; n=9616) were in a nonshockable rhythm, such as asystole or pulseless electrical activity (PEA). Only 17.8% (n=2079) of patients in the study were in a shockable rhythm (ventricular fibrillation and pulseless ventricular tachycardia). AEDs were used on 4515 patients (38.6%). An overall survival to discharge rate of 18.1% (n=2117) was reported. The use of an AED was associated with lower survival rates (16.3% vs 19.3%; adjusted rate ratio [RR], 0.85; 95% confidence interval [CI], 0.78-0.92; P<0.001). AED use in those patients with asystole or PEA (unshockable rhythms) was associated with lower survival (10.4% vs 15.4%; adjusted RR, 0.74; 95% CI, 0.65-0.83; P<0.001). Where shockable rhythms, such as ventricular tachycardia or ventricular fibrillation, were present, AED use did not increase survival (38.4% vs 39.8%; adjusted RR, 1.00; 95% CI, 0.88-1.13; P=0.99). These trends were consistent for AED use in both monitored and nonmonitored hospital units (p>.10). For cardiac arrest due to asystole or PEA the use (or not) of an AED did not influence the rates of ROSC. For cardiac arrests due to ventricular fibrillation or pulseless ventricular tachycardia the rates of ROSC and survival at 24 h did not differ by AED use. AED use did not shorten the time to defibrillation and for those patients with ROSC, and was not associated with shorter CPR times or fewer administered defibrillations. Overall the authors concluded that the use of AEDs in hospitalised patients following cardiac arrest was not associated with improved survival.
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Asian Pac J Trop Biomed · Aug 2011
Risk factors and outcomes of imipenem-resistant Acinetobacter bloodstream infection in North-Eastern Malaysia.
To determine the risk factors and outcomes of imipenem-resistant Acinetobacter baumannii (IRAB) bloodstream infection (BSI) cases, since there is very little publication on Acinetobacter baumannii infections from Malaysia. ⋯ Although statistically not significant, this analysis compliments previous publication highlighting the importance of appropriate empiric antibiotic usage in hospital especially carbepenems and need further evaluation with bigger subjects.
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Plasma gelsolin depletion has been associated with poor outcome of critically ill patients. However, there is a paucity of data available on circulating plasma gelsolin concentration in traumatic brain injury (TBI). Thus, we sought to investigate change in plasma gelsolin level after TBI and to evaluate its relation with disease outcome. ⋯ Decreased plasma gelsolin level is associated with GCS scores and an independent prognostic marker of mortality after TBI. Reversing plasma gelsolin deficiency may be an effective treatment for TBI.
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Pediatr Crit Care Me · Jul 2011
CommentA critical appraisal of Vlasselaers D, Milants I, Desmet L, et al: intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet 2009; 373:547-556.
To review findings and discuss implications of strict glycemic control in children. ⋯ This was a well-designed single-center trial that serves as proof of concept. The effects of intensive insulin therapy on mortality require further investigation, and its practice may need refinement to reduce the risk of hypoglycemia. In the meantime, targeting age-adjusted fasting glucose ranges cannot be routinely recommended in critically ill children.
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What is the role of steroids in septic shock in the emergency department? ⋯ To assess the safety and efficacy of low-dose hydrocortisone therapy for patients with septic shock and to compare outcomes based on response to corticotropin testing.