Crit Care Resusc
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Recent research suggests an association between the development of acute lung injury (ALI) and mechanical ventilation with tidal volumes > 6mL per kg of predicted body weight (BW). Specific subgroups (women and obese patients) may be at risk of unintentional delivery of excessive tidal volumes. We conducted a prospective audit of delivered tidal volumes (mL/kg) calculated using recorded BW and compared these to volumes calculated using predicted BW. ⋯ Predicted BW was significantly less than recorded BW. Consequently, larger tidal volumes were delivered on a mL/kg basis when calculated using predicted BW than recorded BW. This was particularly so for women, who received higher volumes than men when using predicted BW. Calculating predicted BW using demispan as a surrogate marker of height is a cheap, easy and noninvasive tool for clinical assessment; its use in the ICU may result in the delivery of more appropriate tidal volumes.
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To improve the documentation of events surrounding medical emergency team (MET) calls and to audit the incidence of MET calls and subsequent patient outcomes. ⋯ Critical-care resource utilisation and inhospital mortality risk following a MET call at our institution is high. Three simple interventions improved the quality of medical documentation but did not significantly increase overall resource utilisation or improve patient outcomes.
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The Royal Children's Hospital, Melbourne, Victoria, provides extracorporeal life support (ECLS) for infants and children from all around Australia. Since 2003, we have offered a mobile ECLS service to retrieve critically ill children whose condition is too unstable for conventional transport. The retrieval team comprises a paediatric intensive care unit specialist, an ECLS nurse specialist, a perfusionist and a cardiac surgeon. ⋯ This is the first report of ECLS transport in Australia. In our experience, children who would not otherwise be transportable can be safely transported long distances on ECLS, and should be offered this if appropriate resources exist. However, this approach should not replace the timely referral of patients who are likely to need ECLS.
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A 40-year old Indigenous woman with a history of mitral valve replacement was admitted to the Royal Darwin Hospital, Northern Territory, for an elective cone biopsy of the cervix. During the admission, she had recurrent fever and joint pain of the left knee. ⋯ Abiotrophia defectiva was identified from the culture, and a transoesophageal echocardiogram revealed endocarditis of the mitral valve prosthesis. A review of the English-language literature suggests that this is the first reported case of Abiotrophia endocarditis in Australia, and the third reported case of prosthetic-valve endocarditis caused by this species worldwide.