Critical care : the official journal of the Critical Care Forum
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How good is the care patients receive during interhospital transfer? The results of a study in this journal make for some disturbing reading. Adverse events occur in about one-third of cases. ⋯ So how do we make things better? All transfer equipment needs to be standardized and be "fit-for-purpose". Each hospital needs to take responsibility for the quality of care received in transfer, and this should include guidelines, training and equipment.
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In this issue of Critical Care, Bollen and colleagues present the results of a multicentre randomised controlled trial, comparing high-frequency oscillatory ventilation with conventional ventilation as the primary ventilation mode for adults with acute respiratory distress syndrome. The study was stopped early after recruiting only 61 patients because of declining enrolment, and although no differences were detected in any primary or secondary endpoint, this trial only had sufficient power to detect extreme differences in outcomes between groups. This editorial attempts to put these results in context with previous work and highlights challenges to be addressed in future studies.
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Delirium is a frequently occurring but often under-diagnosed and under-treated problem in the intensive care unit (ICU). It has been linked to adverse outcome, increased length of stay and higher mortality in critically ill patients. A study by Thomason and coworkers published in this issue of Critical Care deals with the issue of delirium and its consequences in less severely ill patients. This commentary aims to provide context for this study, discussing its potential implications as well as the potential therapeutic and preventive measures in patients with hyperactive or hypoactive delirium.
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Tracheostomies have been around for close to 3000 years, so one would hope that the controversies might have been thrashed out by now, but apparently not. Judging by some recent publications it would appear that we still do not know when or how to insert them. ⋯ The intensive care unit imposes a heavy treatment burden, particularly on the elderly. What impact does this have on the lives of the survivors?