scholarly journals High-Dose Adrenaline in Adult In-Hospital Asystolic Cardiopulmonary Resuscitation: A Double-Blind Randomised Trial

1993 ◽  
Vol 21 (2) ◽  
pp. 192-196 ◽  
Author(s):  
J. Lipman ◽  
W. Wilson ◽  
S. Kobilski ◽  
J. Scribante ◽  
C. Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Side Effects ◽  
Cardiopulmonary Resuscitation ◽  
Standard Dose ◽  
Randomised Trial ◽  
High Dose ◽  
Double Blind ◽  
To Receive

Forty intensive care unit patients requiring cardiopulmonary resuscitation were randomised to receive either the standard dose of adrenaline (1 mg every five minutes) or high-dose adrenaline (10 mg every five minutes). In the majority of patients, overwhelming sepsis was the major contributing factor leading to cardiac arrest. In this group of patients no difference could be detected in response to high-dose adrenaline compared with the standard dose. Although no side-effects were noted with this high dose of adrenaline, more investigation is required prior to its routine use in cardiopulmonary resuscitation.

Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease

2007 ◽  
Vol 17 (S4) ◽  
pp. 116-126 ◽  
Author(s):  
Stacie B. Peddy ◽  
Mary Fran Hazinski ◽  
Peter C. Laussen ◽  
Ravi R. Thiagarajan ◽  
George M. Hoffman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Intensive Care Units ◽  
Cardiac Disease ◽  
Paediatric Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
Paediatric Intensive Care Units

AbstractPulseless cardiac arrest, defined as the cessation of cardiac mechanical activity, determined by unresponsiveness, apneoa, and the absence of a palpable central pulse, accounts for around one-twentieth of admissions to paediatric intensive care units, be they medical or exclusively cardiac. Such cardiac arrest is higher in children admitted to a cardiac as opposed to a paediatric intensive care unit, but the outcome of these patients is better, with just over two-fifths surviving when treated in the cardiac intensive care unit, versus between one-sixth and one-quarter of those admitted to paediatric intensive care units. Children who receive chest compressions for bradycardia with pulses have a significantly higher rate of survival to discharge, at 60%, than do those presenting with pulseless cardiac arrest, with only 27% surviving to discharge. This suggests that early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes. Recently published reports of in-hospital cardiac arrests in children can be derived from the multi-centric National Registry of Cardiopulmonary Resuscitation provided by the American Heart Association. The population is heterogeneous, but most arrests occurred in children with progressive respiratory insufficiency, and/or progressive circulatory shock. During the past 4 years at the Children’s Hospital of Philadelphia, 3.1% of the average 1000 annual admissions to the cardiac intensive care unit have received cardiopulmonary resuscitation. Overall survival of those receiving cardiopulmonary resuscitation was 46%. Survival was better for those receiving cardiopulmonary resuscitation after cardiac surgery, at 53%, compared with survival of 33% for pre-operative or non-surgical patients undergoing resuscitation. Clearly there is room for improvement in outcomes from cardiac resuscitation in children with cardiac disease. In this review, therefore, we summarize the newest developments in paediatric resuscitation, with an expanded focus upon the unique challenges and importance of anticipatory care in infants and children with cardiac disease.

scholarly journals Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit

Resuscitation ◽  
2009 ◽  
Vol 80 (10) ◽  
pp. 1124-1129 ◽  
Author(s):  
Parthak Prodhan ◽  
Richard T. Fiser ◽  
Umesh Dyamenahalli ◽  
Jeffrey Gossett ◽  
Michiaki Imamura ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Cardiopulmonary Resuscitation

scholarly journals Postoperative Cardiac Arrest after Heart Surgery: Does Extracorporeal Perfusion Support a Paradigm Change in Management?

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Edward Gologorsky ◽  
Francisco Igor B. Macedo ◽  
Enisa M. Carvalho ◽  
Angela Gologorsky ◽  
Marco Ricci ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Heart Surgery ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Neurological Function ◽  
Paradigm Change

Early institution of extracorporeal perfusion support (ECPS) may improve survival after cardiac arrest. Two patients sustained unexpected cardiac arrest in the Intensive Care Unit (ICU) following cardiac interventions. ECPS was initiated due to failure to restore hemodynamics after prolonged (over 60 minutes) advanced cardiac life support (ACLS) protocol-guided cardiopulmonary resuscitation. Despite relatively late institution of ECPS, both patients survived with preserved neurological function. This communication focuses on the utility of ECPS in the ICU as a part of resuscitative efforts.

The Safe Use of High Dose Neuroleptics in a Psychiatric Intensive Care Unit

1986 ◽  
Vol 20 (3) ◽  
pp. 370-375 ◽  
Author(s):  
Robert D. Goldney ◽  
Neil D. Spence ◽  
Julia A. Bowes
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Sudden Death ◽  
High Dose ◽  
High Doses

A review of the use of high dose neuroleptics in the management of acute psychoses in a psychiatric intensive care unit confirms the previously reported safety of such regimes. The risk of extreme unwanted effects, such as cardiac arrest and sudden death, was considerably less than the risk of suicide as an inpatient. Although high doses of neuroleptics appear to be relatively safe, there is no advantage, in terms of the length of admission required in the intensive care unit, in using a dose of neuroleptic above the equivalent of 60-80 mg of haloperidol in any one 24-hour period.

Factors Associated with Survival and Neurological Outcome after Cardiopulmonary Resuscitation of Neurosurgical Intensive Care Unit Patients

Neurosurgery ◽  
2006 ◽  
Vol 59 (4) ◽  
pp. 838-846 ◽  
Author(s):  
Hyeong-Joong Yi ◽  
Young-Soo Kim ◽  
Yong Ko ◽  
Suck-Jun Oh ◽  
Kwang-Myung Kim ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Factors Associated ◽  
Neurosurgical Patients ◽  
Neurosurgical Intensive Care ◽  
Vestibular Reflex ◽  
Neurosurgical Intensive Care Unit

Abstract OBJECTIVE: We investigated predictors of survival and the neurological outcomes of neurosurgical patients who experienced cardiac arrest and received cardiopulmonary resuscitation after being admitted to the neurosurgical intensive care unit. METHODS: A retrospective study was conducted of adult patients in the neurosurgical intensive care unit who had experienced cardiac arrest and received cardiopulmonary resuscitation. Factors relevant to the cardiac arrest (before and after arrest) were used to study association with survival (immediate or short-term) and neurological outcome (unconscious or conscious) via statistical methods. RESULTS: Immediate survival was seen in 105 patients (49%), 19 survived until hospital discharge, and 11 were still alive at the conclusion of this study. Of the immediate survivors, 41 patients were conscious and 64 were unconscious. Multivariate analysis showed increased mortality in patients with infection, asystole, or resuscitation time exceeding 30 minutes (P < 0.05). Additional factors associated with high in-hospital mortality included lack of spontaneous respiration, no caloric-vestibular reflex, and unconsciousness after resuscitation (P < 0.05). In addition, neurological recovery was poor in patients with infection, asystole, no caloric-vestibular reflex, conscious recovery, or resuscitation lasting more than 30 minutes (P < 0.05). CONCLUSION: Even after initially successful resuscitation, survival and neurological recovery is quite dismal in patients with cerebral lesions. Prognostic factors for neurosurgical patients should be assessed on an individual basis to determine medical futility in the early post-resuscitation period.

scholarly journals A importância do treinamento em PCR e RCP para os profissionais de enfermagem em unidade de terapia intensiva

2011 ◽  
Vol 1 (2) ◽  
pp. 11
Author(s):  
Fernando Graton Alves ◽  
Luiz Faustino dos Santos Maia
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Early Identification ◽  
Outcomes Of Care ◽  
Training Professionals ◽  
Terapia Intensiva ◽  
And Performance ◽  
Nursing Professionals

Dentre as diversas situações que ocorrem em uma unidade de terapia intensiva, indubitavelmente nenhuma supera a prioridade de atendimento a uma parada cardiorrespiratória. Ações organizadas e planejadas diminuem as sequelas e influenciam nos resultados do atendimento. Os treinamentos também são importantes na identificação prévia de uma parada cardiorrespiratória. Este trabalho tem como objetivo discorrer sobre a importância do treinamento em parada cardiorrespiratória e ressuscitação cardiopulmonar em unidade de terapia intensiva para os profissionais de enfermagem. O método utilizado para tecer este estudo foi através de pesquisa bibliográfica. Os resultados evidenciaram que após um período de treinamento os profissionais melhoraram a qualidade e o desempenho no atendimento à parada cardiorrespiratória. Educação permanente deve ser incentivada e mantida sistematicamente para garantir um bom desempenho da equipe.Descritores: Parada Cardiorrespiratória, Ressuscitação Cardiopulmonar, Enfermagem.The importance of training in cardiac arrest and CPR for the professional nursing in the intensive care unitAbstract: Among the various situations that occur in an intensive care unit, no doubt exceeds the priority of service to a cardiac arrest. Organized and planned actions diminish the legacy and influence the outcomes of care. The trainings are also important in early identification of a cardiac arrest. This paper aims to discuss the importance of training in cardiac arrest and cardiopulmonary resuscitation in the intensive care unit for nursing professionals. The method used for this study was to weave through bibliographic research. The results showed that after a period of training professionals have improved the quality and performance in the care of cardiac arrest. Continuing education should be encouraged and maintained to ensure a consistently good team performance.Descriptors: Cardiorespitatory Arrest, Cardiopulmonary Resuscitation, Nursing.La importáncia del entrenamiento en paro cardíaco y resucitación cardiopulmonar para el profesional de enfermería en la unidad de cuidados intensivosResumen: Entre las diversas situaciones que ocurrren en uma unidad de cuidados intensivos, sin lugar a dudas ninguna supera la prioridad del atendimiento a un paro cardíaco. Acciones organizadas y planeadas disminuyen las consecuencias e influencian en los resultados del atendimiento. Los entrenamientos también son importantes en la identificación previa de un paro cardiaco. Esta investigación tiene el objetivo de explicar acerca de la importancia del entrenamiento en paro cardiaco y resuscitación cardiopulmonar en unidad de cuidados intensivos para los profesionales de enfermería. El método utilizado para hacer dicha investigación fue a través de investigación bibliográfica. Los resultados evidenciaron que tras un período de entrenamiento los profesionales han mejorado la calidad y el desempeño en el atendimiento a un paro cardiaco. La educación permanente debe ser incentivada y mantenida sistematicamente para garantizar un bueno desempeño del equipo.Descriptores: Parada Cardiorrespiratória, Reanimación Cardiopulmonar, Enfermería. 

scholarly journals A Comparison of xylometazoline (Otrivine) and phenylephrine/lignocaine mixture (Cophenylcaine) for the purposes of rigid nasendoscopy: a prospective, double-blind, randomised trial

2008 ◽  
Vol 123 (6) ◽  
pp. 626-630 ◽  
Author(s):  
N A McCluney ◽  
C Y Eng ◽  
M S W Lee ◽  
L G McClymont
Keyword(s):  
Side Effects ◽  
Statistical Methods ◽  
Nasal Spray ◽  
Randomised Trial ◽  
Visual Analogue Score ◽  
Significant Extent ◽  
Double Blind ◽  
To Receive ◽  
Better Than

AbstractObjective:To evaluate if phenylephrine–lignocaine mixture (Cophenylcaine) nasal spray performs better than xylometazoline (Otrivine) spray for the purposes of out-patient rigid nasendoscopy preparation.Design:Prospective, double-blind, randomised trial comparing visual analogue scores for out-patients receiving either phenylephrine–lignocaine mixture or xylometazoline, prior to undergoing rigid nasendoscopy as part of their assessment.Subjects:Seventy-three patients requiring rigid nasendoscopy as part of their assessment were recruited to the study from Raigmore Hospital's out-patient clinic. These patients were randomised to receive a nasal spray comprising either phenylephrine–lignocaine mixture or xylometazoline, 10 minutes prior to rigid nasendoscopy. Double-blinding was adopted. After the procedure, the patient and the doctor independently completed separate visual analogue score-based questionnaires regarding the pain of the procedure and the ease of the examination, respectively.Results:Analysis of the data using standardised statistical methods demonstrated that the phenylephrine–lignocaine mixture did not perform better than xylometazoline, to any statistically significant extent.Conclusion:Phenylephrine–lignocaine mixture is considerably more expensive and has potentially more side effects than xylometazoline. These study findings suggest that it is difficult to justify the use of phenylephrine–lignocaine mixture over xylometazoline, for nasal preparation prior to rigid nasendoscopy.

scholarly journals A cohort study investigating the occurrence of differences in care provided to men and women in an intensive care unit

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Erik Zettersten ◽  
Gabriella Jäderling ◽  
Max Bell ◽  
Emma Larsson
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Arrest ◽  
Cohort Study ◽  
Intensive Care ◽  
Respiratory Disease ◽  
University Hospital ◽  
Men And Women ◽  
Logistic Regressions ◽  
To Receive

AbstractIt has been reported that there are differences in the care given within the intensive care unit (ICU) between men and women. The aim of this study is to investigate if any differences still exist between men and women regarding the level of intensive care provided, using prespecified intensive care items. This is a retrospective cohort study of 9017 ICU patients admitted to a university hospital between 2006 and 2016. Differences in use of mechanical ventilation, invasive monitoring, vasoactive treatment, inotropic treatment, echocardiography, renal replacement therapy and central venous catheters based on the sex of the patient were analysed using univariate and multivariable logistic regressions. Subgroup analyses were performed on patients diagnosed with sepsis, cardiac arrest and respiratory disease. Approximately one third of the patients were women. Overall, men received more mechanical ventilation, more dialysis and more vasoactive treatment. Among patients admitted with a respiratory disease, men were more likely to receive mechanical ventilation. Furthermore, men were more likely to receive levosimendan if admitted with cardiac arrest. We conclude that differences in the level of intensive care provided to men and women still exist.

scholarly journals Pharmacokinetics and Tolerability of a Higher Rifampin Dose versus the Standard Dose in Pulmonary Tuberculosis Patients

2007 ◽  
Vol 51 (7) ◽  
pp. 2546-2551 ◽  
Author(s):  
Rovina Ruslami ◽  
Hanneke M. J. Nijland ◽  
Bachti Alisjahbana ◽  
Ida Parwati ◽  
Reinout van Crevel ◽  
...  
Keyword(s):  
Dose Group ◽  
Standard Dose ◽  
High Dose ◽  
Double Blind ◽  
Time Curve ◽  
Tb Treatment ◽  
Randomized Phase Ii ◽  
Proportional Increase ◽  
To Receive

ABSTRACT Rifampin is a key drug for tuberculosis (TB) treatment. The available data suggest that the currently applied 10-mg/kg of body weight dose of rifampin may be too low and that increasing the dose may shorten the treatment duration. A double-blind randomized phase II clinical trial was performed to investigate the effect of a higher dose of rifampin in terms of pharmacokinetics and tolerability. Fifty newly diagnosed adult Indonesian TB patients were randomized to receive a standard (450-mg, i.e., 10-mg/kg in Indonesian patients) or higher (600-mg) dose of rifampin in addition to other TB drugs. A full pharmacokinetic curve for rifampin, pyrazinamide, and ethambutol was recorded after 6 weeks of daily TB treatment. Tolerability was assessed during the 6-month treatment period. The geometric means of exposure to rifampin (area under the concentration-time curve from 0 to 24 h [AUC0-24]) were increased by 65% (P < 0.001) in the higher-dose group (79.7 mg·h/liter) compared to the standard-dose group (48.5 mg·h/liter). Maximum rifampin concentrations (C max) were 15.6 mg/liter versus 10.5 mg/liter (49% increase; P < 0.001). The percentage of patients for whom the rifampin C max was ≥8 mg/liter was 96% versus 79% (P = 0.094). The pharmacokinetics of pyrazinamide and ethambutol were similar in both groups. Mild (grade 1 or 2) hepatotoxicity was more common in the higher-dose group (46 versus 20%; P = 0.054), but no patient developed severe hepatotoxicity. Increasing the rifampin dose was associated with a more than dose-proportional increase in the mean AUC0-24 and C max of rifampin without affecting the incidence of serious adverse effects. Follow-up studies are warranted to assess whether high-dose rifampin may enable shortening of TB treatment.

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