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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Recommendations exist to guide the design and construction of adult intensive care units, but current guidelines are hampered by the paucity of high-quality research. Much of the current literature on ICU design has focused on patient-centred outcomes, such as nosocomial infections, aspects of psychological and physiological wellbeing, and patient satisfaction, but the design of the ICU environment also affects health care workers. ⋯ For most aspects of ICU design, more research is required before definite conclusions can be drawn. This article discusses the application of evidence-based design to improve the ICU environment and reviews some of the controversial issues and concepts.
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We report a case in which intensive care doctors and nurses became involved in the care of a young chimpanzee who required ventilation for pneumonia at Wellington Zoo, New Zealand. This required staff to work outside the usual protected environment of a hospital intensive care unit. The chimpanzee, Bahati, was ventilated for 3 days, replicating intensive care practice, but died. ⋯ Euthanasia was an unfamiliar process to ICU staff. Bahati's death received national media attention and some criticism of the involvement of intensive care staff. The zoo staff were overwhelmed and grateful that everything possible was done for Bahati.