Crit Care Resusc
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To describe the incidence, clinical characteristics and outcomes of critically ill patients in Ireland with pandemic (H1N1) 2009 infection, and to provide a dynamic assessment of the burden of such cases on Irish intensive care units. ⋯ The 2009 influenza A (H1N1) pandemic was a significant burden on Irish ICUs, predominantly affecting the tertiary centres. The demographics and clinical characteristics were similar to those described in the southern hemisphere, suggesting such data may inform future resource planning for similar threats.
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Patients receiving extracorporeal membrane oxygenation (ECMO) are some of the most critically ill in the intensive care unit. In such patients, malnutrition is associated with increased morbidity and mortality. ⋯ Patients receiving ECMO received inadequate nutritional support, with only 55% of their nutritional targets being achieved while receiving ECMO. Optimal nutritional support should be a major goal in the care of these patients, and measures to improve nutritional delivery require careful consideration.
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The correct renal response to metabolic acidosis should be a negative shift in the urinary strong ion difference ([SID](urinary) = [Na(+)](urinary) + [K(+)](urinary) - [Cl(-)](urinary)). Our hypothesis was that the failure to decrease the [SID](urinary) is frequently present and leads to a more severe metabolic acidosis. ⋯ Most of the critically ill patients with metabolic acidosis showed inappropriate renal compensation, as evidenced by positive [SID](urinary) and higher plasma [Cl(-)]. These patients had more severe metabolic acidosis. On the other hand, patients with adequate renal response and negative [SID](urinary) had positive Δ[AG] - Δ[HCO(3)(-)]. These findings, usually considered as a diagnosis of associated metabolic alkalosis, might be interpreted as the proper renal response to metabolic acidosis.
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Multicenter Study
A survey of the use of ventilator hyperinflation in Australian tertiary intensive care units.
To ascertain the prevalence of use of ventilator hyperinflation (VHI) by physiotherapists practising in tertiary Australian intensive care units in the management of artificially ventilated patients, and whether standard protocols are in place in these facilities. ⋯ Our survey provides information on the nature and the extent of VHI utilisation by physiotherapists in Australian tertiary ICUs. These data can now be pooled to develop standardised evidence-based VHI protocols for both spontaneous and controlled ventilation modes.
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To identify the resource usage by patients with influenza A H1N1 admitted to Australian and New Zealand intensive care units during the first wave of the pandemic in June, July and August 2009. ⋯ Low rates of admission of H1N1 patients to ICUs during the 2009 pandemic enabled the intensive care system to cope with the large demand when analysed at a jurisdictional level.