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A study to ascertain the mortality rate when vasopressin and norepinephrine were used on patients with refractory septic shock is conducted. Results show no significant difference between patients treated with low-dose vasopressin and norepinephrine compared to catecholamine vasopressors.

The effect of a "lung open ventilation" (LOV) strategy on mortality in patients with acute lung injury and acute respiratory distress syndrome is described. A combination of low tidal volumes, recruitment maneuvers, and high levels of positive end-expiratory pressure shows no significant difference in all-cause hospital mortality compared with low-tidal-volume protocolized ventilation strategy.

The impact of prehospital resuscitation with intravenous hypertonic saline (HTS) on long-term neurological outcome in patients with severe traumatic brain injury (TBI) is examined. Identical neurological function was found six months after injury in patients receiving prehospital resuscitation and in patients receiving conventional fluid.

Background: There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months.Methods: In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM.Results: Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51-70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06-13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, - 0.19 [- 0.28 to - 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty.Conclusions: At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registration NCT04401254 May 26, 2020. [ABSTRACT FROM AUTHOR]

Contractility of the left ventricle increases at higher doses of histamine and at low doses of histamine, left ventricular contractility decreases. The stimulation of the H2-receptor is responsible for the higher rate of contraction. The stimulation of H1-receptor decreases the left ventricular contractility. The shift of the end-systolic pressure-volume relation is a measurement of the change in the left ventricular contractile function. The end-systolic pressure-volume relation is largely increased by the injection of low doses of histamine.

The critical level of oxygen delivery for anaerobic metabolism may be significantly lower than previously estimated. The body switches to anaerobic metabolism if oxygen delivery to the cells drops below a critical level. Anaerobic metabolism does not require oxygen, but can cause damage to vital organs. Researchers examined oxygen delivery and consumption in 18 critically ill patients. Nine patients were septic, and nine were not. Sepsis is the presence of bacteria and their toxins in the blood and other tissues. A relationship was found between oxygen delivery and oxygen consumption in all the septic patients and eight non-septic patients. The critical level of oxygen delivery was the same for both groups of patients and lower than the value calculated from pooled data. Treatment to increase oxygen delivery may not be appropriate for critically ill patients.

Objectives: To describe the characteristics and outcomes of patients with COVID‐19 admitted to intensive care units (ICUs) during the initial months of the pandemic in Australia. Design, setting: Prospective, observational cohort study in 77 ICUs across Australia. Participants: Patients admitted to participating ICUs with laboratory‐confirmed COVID‐19 during 27 February – 30 June 2020. Main outcome measures: ICU mortality and resource use (ICU length of stay, peak bed occupancy). Results: The median age of the 204 patients with COVID‐19 admitted to intensive care was 63.5 years (IQR, 53–72 years); 140 were men (69%). The most frequent comorbid conditions were obesity (40% of patients), diabetes (28%), hypertension treated with angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers (24%), and chronic cardiac disease (20%); 73 patients (36%) reported no comorbidity. The most frequent source of infection was overseas travel (114 patients, 56%). Median peak ICU bed occupancy was 14% (IQR, 9–16%). Invasive ventilation was provided for 119 patients (58%). Median length of ICU stay was greater for invasively ventilated patients than for non‐ventilated patients (16 days; IQR, 9–28 days v 3 days; IQR, 2–5 days), as was ICU mortality (26 deaths, 22%; 95% CI, 15–31% v four deaths, 5%; 95% CI, 1–12%). Higher Acute Physiology and Chronic Health Evaluation II (APACHE‐II) scores on ICU day 1 (adjusted hazard ratio [aHR], 1.15; 95% CI, 1.09–1.21) and chronic cardiac disease (aHR, 3.38; 95% CI, 1.46–7.83) were each associated with higher ICU mortality. Conclusion: Until the end of June 2020, mortality among patients with COVID‐19 who required invasive ventilation in Australian ICUs was lower and their ICU stay longer than reported overseas. Our findings highlight the importance of ensuring adequate local ICU capacity, particularly as the pandemic has not yet ended. [ABSTRACT FROM AUTHOR]

The article present a study on long-term outcomes following severe traumatic brain injury in older adults. Topics discussed include population of Victoria, Australia and the number of older adults (aged more than 65 years) hospitalized with severe traumatic brain injury; treatment and hospital outcomes of older adults admitted to an intensive care unit with severe traumatic brain injury; and clinical features associated with recovery to functional independence.

Background: Little is currently known about nutrition intake and energy requirements in the post-intensive care unit (ICU) hospitalization period in critically ill patients. We aimed to describe energy and protein intake, and determine the feasibility of measuring energy expenditure during the post-ICU hospitalization period in critically ill adults.Methods: This is a nested cohort study within a randomized controlled trial in critically ill patients. After discharge from ICU, energy and protein intake was quantified periodically and indirect calorimetry attempted. Data are presented as n (%), mean (SD), and median (interquartile range [IQR]).Results: Thirty-two patients were studied in the post-ICU hospitalization period, and 12 had indirect calorimetry. Mean age and BMI was 56 (18) years and 30 (8) kg/m2 , respectively, 75% were male, and the median estimated energy and protein requirement were 2000 [1650-2550] kcal and 112 [84-129] g, respectively. Oral nutrition either alone (n = 124 days, 55%) or in combination with enteral nutrition (n = 96 days, 42%) was the predominant mode. Over 227 total days in the post-ICU hospitalization period, a median [IQR] of 1238 [869-1813] kcal and 60 [35-89.5] g of protein was received from nutrition therapy. In the 12 patients who had indirect calorimetry, the median measured daily energy requirement was 1982 [1843-2345] kcal and daily energy deficit was -95 [-1050 to 347] kcal compared with the measured energy requirement.Conclusions: Energy and protein intake in the post-ICU hospitalization period was less than estimated and measured energy requirements. Oral nutrition provided alone was the most common mode of nutrition therapy. [ABSTRACT FROM AUTHOR]