Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units

INTRODUCTION: Recent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients. METHODS: We conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episodes. We used generalized estimating equations to examine the association between patient, prescriber and geographic factors and the type of fluid administered (classified as crystalloid, colloid or blood products). RESULTS: During the 24-hour study period, 1,955 of 5,274 (37.1%) patients received resuscitation fluid during 4,488 resuscitation episodes. The main indications for administering crystalloid or colloid were impaired perfusion (1,526/3,419 (44.6%) of episodes), or to correct abnormal vital signs (1,189/3,419 (34.8%)). Overall, colloid was administered to more patients (1,234 (23.4%) versus 782 (14.8%)) and during more episodes (2,173 (48.4%) versus 1,468 (32.7%)) than crystalloid. After adjusting for patient and prescriber characteristics, practice varied significantly between countries with country being a strong independent determinant of the type of fluid prescribed. Compared to Canada where crystalloid, colloid and blood products were administered in 35.5%, 40.6% and 28.3% of resuscitation episodes respectively, odds ratios for the prescription of crystalloid in China, Great Britain and New Zealand were 0.46 (95% confidence interval (CI) 0.30 to 0.69), 0.18 (0.10 to 0.32) and 3.43 (1.71 to 6.84) respectively; odds ratios for the prescription of colloid in China, Great Britain and New Zealand were 1.72 (1.20 to 2.47), 4.72 (2.99 to 7.44) and 0.39 (0.21 to 0.74) respectively. In contrast, choice of fluid was not influenced by measures of illness severity (for example, Acute Physiology and Chronic Health Evaluation (APACHE) II score). CONCLUSIONS: Administration of resuscitation fluid is a common intervention in intensive care units and choice of fluid varies markedly between countries. Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were

「異文化」の創造的融合の理解と交流を目指した日本語文化研修（Ⅲ） : ""山城地域 (向日・洛西・宇治) の文化史""の実地研修

In the last paper, a field trip to study regional cultures held during the Japanese language and culture courses of a university was analyzed and problems were summarized for future plans and practices of study camps and field trips. This paper focuses on a field trip to study regional cultures of Yamashiro. It is planned and put into practice for the purpose of understanding the cultures of Mukoo district, Rakusai district and Uji district of Kyoto Prefecture. Its characteristics are summarized as follows: 1 This field trip is especially attaches importance to understanding creative cultural fusion and promoting exchage. 2 This field trip is a result of two field trips in Kyoto, a study camp in Hiroshima City, a small field trip in Hiroshima Prefecture, a field trip in Setouchi, a field trip in Shimane Prefecture, a field trip in Geiyo district, a field trip in West Chugoku district, a field trip in Yamato district, a field trip in Kibi district, a field trip in Tsukushi district, a field trip in Oomi district, a field trip in Sanuki and Tosa district, a field trip in Settsu and Yamato district and a field trip in Buzen and Bungo district. 3 A regional study concerning history of culture in Mukoo, Rakusai and Uji district, is stressed in this trip. 4 This field trip includes four lectures, three investigations with lecturers and a free talk by local speakers. 5 This field trip is planned and put into practice mainly by students who are members of the Hijiyama University Japanese Language Culture Course. 6 There are 13 participants (including a foreign student) who are enrolled in 'Nihongobunka Kenshuu (Japanese Language and Culture Training Course) ' for third year students. 7 An inspection trip by teachers was also made before this field trip. Practices of the field trip are analyzed based on questionnaires filled out by the participants. Then, problems are summarized for future field trips