Boylelohmann1669

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OBJECTIVE Pleural effusions in the intensive care unit (ICU) are clinically important. However, there is limited information regarding effusions in such patients. We aimed to estimate the prevalence, patient characteristics, mortality, effusion duration, radiological resolution, drainage, and reaccumulation rates of pleural effusions in ICU patients. METHODS This retrospective cohort study assessed all patients admitted to a tertiary hospital ICU from 1 January to 31 December 2015 with a chest x-ray report of pleural effusion. All chest x-ray reports were reviewed and data were combined with an established clinical ICU database. Statistical analysis of the combined dataset was performed. RESULTS Among 2094 patients admitted to the ICU, 566 (27%) had pleural effusions diagnosed by chest x-ray. selleck chemicals The effusion median duration was 3 days (IQR, 1-5 days). Radiologically documented clearance of the effusion occurred in 243 patients (43%) and drainage was performed in 52 patients (9%). Among patients with effusion clearance, 80 (33%) reaccumulated the effusion. Drainage was more common in patients who experienced reaccumulation (19% v 7%; P = 0.004). Overall, 89 patients (16%) died, with 20% mortality among those with reaccumulation versus 9% among patients without reaccumulation (P = 0.037). CONCLUSION Pleural effusions are common in ICU patients and drainage is infrequent. One-third of effusions reaccumulate, even after drainage, and one in six patients with an effusion die in hospital. This information helps clinicians estimate resolution rates, advantages and disadvantages of effusion drainage, and overall prognosis.OBJECTIVE The apparent survival benefit of being overweight or obese in critically ill patients (the obesity paradox) remains controversial. Our aim is to report on the epidemiology and outcomes of obesity within a large heterogenous critically ill adult population. DESIGN Retrospective observational cohort study. SETTING Intensive care units (ICUs) in Australia and New Zealand. PARTICIPANTS Critically ill patients who had both height and weight recorded between 2010 and 2018. OUTCOME MEASURES Hospital mortality in each of five body mass index (BMI) strata. Subgroups analysed included diagnostic category, gender, age, ventilation status and length of stay. RESULTS Data were available for 381 855 patients, 68% of whom were overweight or obese. Increasing level of obesity was associated with lower unadjusted hospital mortality underweight (11.9%), normal weight (7.7%), overweight (6.4%), class I obesity (5.4%), and class II obesity (5.3%). After adjustment, mortality was lowest for patients with class I obesity (adjusted odds ratio, 0.78; 95% CI, 0.74- 0.82). Adverse outcomes with class II obesity were only seen in patients with cardiovascular and cardiac surgery ICU admission diagnoses, where mortality risk rose with progressively higher BMIs. CONCLUSION We describe the epidemiology of obesity within a critically ill Australian and New Zealand population and confirm that some level of obesity is associated with lower mortality, both overall and across a range of diagnostic categories and important subgroups. Further research should focus on potential confounders such as nutritional status and the appropriateness of BMI in isolation as an anthropometric measure in critically ill patients.BACKGROUND Patients with prolonged cardiac arrest that is not responsive to conventional cardiopulmonary resuscitation have poor outcomes. The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest has shown promising results in carefully selected cases. We sought to validate the results from an earlier extracorporeal cardiopulmonary resuscitation (ECPR) study (the CHEER trial). METHODS Prospective, consecutive patients with refractory in-hospital (IHCA) or out-of-hospital cardiac arrest (OHCA) who met predefined inclusion criteria received protocolised care, including mechanical cardiopulmonary resuscitation, initiation of ECMO, and early coronary angiography (if an acute coronary syndrome was suspected). RESULTS Twenty-five patients were enrolled in the study (11 OHCA, 14 IHCA); the median age was 57 years (interquartile range [IQR], 39-65 years), and 17 patients (68%) were male. ECMO was established in all patients, with a median time from arrest to ECMO support of 57 minutes (IQR, 38-73 min). Percutaneous coronary intervention was performed on 18 patients (72%). selleck chemicals The median duration of ECMO support was 52 hours (IQR, 24-108 h). Survival to hospital discharge with favourable neurological recovery occurred in 11/25 patients (44%, of which 72% had IHCA and 27% had OHCA). When adjusting for lactate, arrest to ECMO flow time was predictive of survival (odds ratio, 0.904; P = 0.035). CONCLUSION ECMO for refractory cardiac arrest shows promising survival rates if protocolised care is applied in conjunction with predefined selection criteria.OBJECTIVE To study the cardiovascular effect over 30 minutes following the end of fluid bolus therapy (FBT) with 20% albumin in patients after cardiac surgery. DESIGN Prospective observational study. SETTING Intensive care unit of a tertiary university-affiliated hospital. PARTICIPANTS Twenty post-cardiac surgery mechanically ventilated patients with a clinical decision to administer FBT. INTERVENTION FBT with a 100 mL bolus of 20% albumin. MAIN OUTCOME MEASURES Cardiac index (CI) response was defined by a ≥ 15% increase, while mean arterial pressure (MAP) response was defined by a ≥ 10% increase. RESULTS The most common indication for FBT was hypotension (40%). Median duration of infusion was 7 minutes (interquartile range [IQR], 3-9 min). At the end of FBT, five patients (25%) showed a CI response, which increased to almost half in the following 30 minutes and dissipated in one patient. MAP response occurred in 11 patients (55%) and dissipated in five patients (45%) by a median of 6 minutes (IQR, 6-10 min). CI and MAP responses coexisted in four patients (20%). An intrabolus MAP response occurred in 17 patients (85%) but dissipated in 11 patients (65%) within a median of 7 minutes (IQR, 2-11 min). On regression analysis, faster fluid bolus administration predicted MAP increase at the end of the bolus. CONCLUSION In post-cardiac surgery patients, CI response to 20% albumin FBT was not congruous with MAP response over 30 minutes. Although hypotension was the main indication for FBT and a MAP response occurred in most of patients, such response was maximal during the bolus, dissipated in a few minutes, and was dissociated from the CI response.