IMPORTANCE Experimental data suggest that intravenous vitamin C may attenuate inflammation and vascular injury associated with sepsis and acute respiratory distress syndrome (ARDS).OBJECTIVE To determine the effect of intravenous vitamin C infusion on organ failure scores and biological markers of inflammation and vascular injury in patients with sepsis and ARDS. DESIGN, SETTING, AND PARTICIPANTSThe CITRIS-ALI trial was a randomized, double-blind, placebo-controlled, multicenter trial conducted in 7 medical intensive care units in the United States, enrolling patients (N = 167) with sepsis and ARDS present for less than 24 hours. The study was conducted from September 2014 to November 2017, and final follow-up was January 2018.INTERVENTIONS Patients were randomly assigned to receive intravenous infusion of vitamin C (50 mg/kg in dextrose 5% in water, n = 84) or placebo (dextrose 5% in water only, n = 83) every 6 hours for 96 hours. MAIN OUTCOMES AND MEASURESThe primary outcomes were change in organ failure as assessed by a modified Sequential Organ Failure Assessment score (range, 0-20, with higher scores indicating more dysfunction) from baseline to 96 hours, and plasma biomarkers of inflammation (C-reactive protein levels) and vascular injury (thrombomodulin levels) measured at 0, 48, 96, and 168 hours. RESULTS Among 167 randomized patients (mean [SD] age, 54.8 years [16.7]; 90 men [54%]), 103 (62%) completed the study to day 60. There were no significant differences between the vitamin C and placebo groups in the primary end points of change in mean modified Sequential Organ Failure Assessment score from baseline to 96 hours (from 9.8 to 6.8 in the vitamin C group [3 points] and from 10.3 to 6.8 in the placebo group [3.5 points]; difference, −0.10; 95% CI, −1.23 to 1.03; P = .86) or in C-reactive protein levels (54.1 vs 46.1 μg/mL; difference, 7.94 μg/mL; 95% CI, −8.2 to 24.11; P = .33) and thrombomodulin levels (14.5 vs 13.8 ng/mL; difference, 0.69 ng/mL; 95% CI, −2.8 to 4.2; P = .70) at 168 hours. CONCLUSIONS AND RELEVANCEIn this preliminary study of patients with sepsis and ARDS, a 96-hour infusion of vitamin C compared with placebo did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury. Further research is needed to evaluate the potential role of vitamin C for other outcomes in sepsis and ARDS.

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Introduction:Noise in the emergency department (ED) may be perceived to be high by both patients and nurses alike. This increased noise level is hypothesized to be responsible for communication interference and subsequent disruption of complex procedures and decision-making. The objective of this study is to quantify ambient noise level in an ED while obtaining coincident subjective surveys from nurses in the assessment of actual versus perceived noise.Methods:Data collected from surveys of ED nurses on each of 3 different dates revealed that sound levels within the selected ED were consistently at or below 70 decibels (dB) of sound as measured by a sound level meter. This level of sound is of the same decibel of normal conversation at a 3–5 foot distance. Nurses surveyed overwhelmingly rated noise as “low” or “not loud” irrespective of a variance (though predominantly within a 10 dB range) in actual sound decibel measurements.Results:Years of experience of work within emergency departments proved the most consistent predictor of nurses’ opinions on the frequency with which noise levels within the ED were louder than they should be, with more experienced nurses all ranking noise levels as “frequently” or “always” louder than they should be.Conclusion:Individual variance existed in how nurses felt that noise level affected work function. ED nurses’ perception of noise is perceived to be low and generally not interfering with their cognitive function.

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introduction: The aim of the study was to explore how the diagnosis of pulmonary embolism was performed between the period of 2002-2006 and the period of 2008-2012. methods: The examination was carried out in Emergency Department of the Kaposi Mor Teaching Hospital in 2013. After the first time period Wells-score pulmonary embolism risk stratification method and the D-dimer test were adapted and the computer tomography introduced generally in patients suspected PE. Those patients have been included in the investigation who died in the hospital and autopsied in the two examined time periods and their pathological diagnosis was pulmonary embolism. 111 patient's post mortem clinical documents were analyzed. In cases where the physician did not perform risk stratification we calculated a follow-up value. results: We found that despite the fact that included in the protocol, as well as the necessary information was available, the physicians were not even once applied the Wells score, therefore we have a posteriori calculated it for each patient. There were 69 patients (80% from 111) who weren't diagnosed with pulmonary embolism in clinical phase. Conversely from the posterior calculations only 8% of the patients have been included in the low-, 73% of the patients included in the intermediate-, and 19% of the patients included in the high probability group. We have concluded that there was significant difference by the rate of the performed CT (p=0,0002) and D-dimer tests (p=0,001) comparing patients under and above 65 years.. The most common inaccurate diagnoses were: bronchopneumonia (n=10), lung cancer (n=9) and myocardial infarct (n=8). Conclusions: The development of the diagnostic tools and the improvement of their accessibility haven't taken a significant change in the successful clinical diagnosis of pulmonary embolism. The patients above 65 years were more neglected than patients less than 65 years because of their longevity, often their hopeless state of health, and not due to the difference in Wells scores.introduction: To estimate the relation between BMI (Body Mass Index) with length of stay in the ICU and hospital. methods: Patients admitted between Jan, 2012 and July, 2013 were included and data was assessed for retrospective analysis. A total of 878 patients were included and the variables collected included age, gender, APS