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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Development and validation of a critical care outcome prediction equation (COPE) using data that are collected routinely for administrative purposes. ⋯ The COPE model is a simple, robust, riskadjusted outcome prediction tool based on five fields from data that are routinely collected for administrative purposes.
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The Fencl-Stewart approach to acid-base physiology allows detailed, quantitative insights into acid-base disorders. We tested the hypothesis that this type of analysis would reveal complex acid-base changes in patients after liver transplantation that differed from those in a general intensive care unit population. ⋯ The Fencl-Stewart approach allowed us to quantitatively assess the factors contributing to patients' acid-base status. We found complex acid-base changes in patients immediately after liver transplantation.
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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.