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Intensive Therapy Unit (intensive + therapy_unit)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Techniques for liver parenchymal transection: a meta-analysis of randomized controlled trials

HPB, Issue 4 2009
Viniyendra Pamecha
Abstract Background:, Different techniques of liver parenchymal transection have been described, including the finger fracture, sharp dissection, clamp,crush methods and, more recently, the Cavitron ultrasonic surgical aspirator (CUSA), the hydrojet and the radiofrequency dissection sealer (RFDS). This review assesses the benefits and risks associated with the various techniques. Methods:, Randomized clinical trials were identified from the Cochrane Library Trials Register, MEDLINE, EMBASE, Science Citation Index Expanded and reference lists. Odds ratio (ORs), mean difference (MDs) and standardized mean differences (SMDs) were calculated with 95% confidence intervals based on intention-to-treat analysis or available-case analysis. Results:, We identified seven trials including a total of 556 patients. Blood transfusion requirements were lower with the clamp,crush technique than with the CUSA or hydrojet. The clamp,crush technique was quicker than the CUSA, hydrojet or RFDS. Infective complications and transection blood loss were greater with the RFDS than with the clamp,crush method. There was no significant difference between techniques in mortality, morbidity, liver dysfunction or intensive therapy unit and hospital stay. Conclusions:, The clamp,crush technique is more rapid and is associated with lower rates of blood loss and otherwise similar outcomes when compared with other methods of parenchymal transection. It represents the reference standard against which new methods may be compared. [source]

Utilizing audit to evaluate improvements in continuous veno-venous haemofiltration practices in intensive therapy unit

NURSING IN CRITICAL CARE, Issue 4 2006
Annette Richardson
Abstract Continuous veno-venous haemofiltration (CVVH) is used regularly in the management of acute renal failure in intensive therapy unit (ITU). A three-staged approach was undertaken involving two audits of practice to improve CVVH record keeping in a 15-bedded cardiac ITU. An initial baseline audit identified a number of areas for improvement in practice. The areas for improvement were implemented then a second audit was repeated. The improvements and practice changes included the dissemination of audit findings to the multidisciplinary team, redesigning the prescription chart to a more user-friendly format and the development of a competency-based CVVH workbook. This nurse-led project demonstrated how positive outcomes and improvements could be achieved with record keeping across the multidisciplinary ITU team. [source]

Continuous Coronary Sinus Perfusion Reverses Ongoing Myocardial Damage in Acute Ischemia

ARTIFICIAL ORGANS, Issue 10 2009
Francesco Onorati
Abstract Acute cardiogenic shock or cardiac arrest (CS/CA) before cardiopulmonary bypass (CPB) installation are life-threatening events in acute coronary syndromes. We evaluated whether continuous retrograde warm-blood perfusion (CRWBP) before aortic cross-clamping (ACC), with immediate CPB installation may improve hospital results in these dreadful events. Hospital outcome of 18 coronary artery bypass grafting (CABG) (Group A) with CS/CA before CPB, with immediate CPB installation and CRWBP, has been compared with 24 CABG (Group B) with CS/CA undergoing only immediate CPB installation. No differences have been detected in the mean time to establish CPB (P = 0.655). Electrocardiography normalized in a significantly higher number of CRWBP (P = 0.0001). Group B showed longer CPB (116.2 ± 21.2 min vs. 157.8 ± 32.4; P = 0.0001) and postoperative intra-aortic balloon pumping time course (36.2 ± 5.9 h vs. 77.8 ± 13.2; P = 0.0001). CRWBP reduced postoperative acute myocardial infarction (P = 0.004) and damage (P = 0.033), death (P = 0.026), and need for high inotropic support (0% vs. 37.5%; P = 0.003). Troponin I was significantly lower in Group A (P = 0.013 from coronary sinus; P , 0.0001 at 12, 24, and 48 h postoperatively; P = 0.008 at 72 h), never reaching values suggestive of acute myocardial infarction. Group A had also lower lactate release from aortic declamping to 48 h postoperatively (P , 0.0001). CRWBP improved postoperative left ventricular ejection fraction (EF) (P = 0.017) and wall motion score index (P = 0.041), whereas Group B showed a significant worsening of EF (P = 0.0001) and wall motion score index (P = 0.002). Patients in Group A had shorter intubation time (P = 0.0001), intensive therapy unit (ITU) stay (P = 0.001), and hospital stay (P = 0.0001). CRWBP reverses myocardial damage in patients with CS/CA during acute coronary syndromes, adding a straightforward benefit to hospital survival. [source]

Self-poisoning with lamotrigine and pregabalin

ANAESTHESIA, Issue 5 2007
A. J. Braga
Summary We report a case of intentional overdose in a 29-year-old male with two of the newer anti-epileptic agents, lamotrigine and pregabalin. To our knowledge, this case report details the highest plasma levels of lamotrigine ever recorded in the literature. The patient presented with seizures and a reduced level of consciousness. Management of these and subsequent complications centres on supportive care in the high dependency and intensive therapy units. [source]