Crit Care Resusc
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To examine nosocomial infections in a cohort of patients receiving extracorporeal life support (ECLS) at our institution and to identify the types of infections, impact of prophylaxis, and any apparent risk factors for infection. ⋯ Although ECLS patients are at high risk of acquiring nosocomial infections, the infection rate in our cohort was low. The bloodstream infection rate compared favourably with previously published rates, and was comparable with the bloodstream infection rate among ICU patients as a whole over the same time period. Increased duration of ECLS in this cohort may correlate with an increased rate of infection, consistent with data from other ECLS centres. Antimicrobial use in ECLS patients was high relative to overall use in ICU patients. Larger studies are warranted to evaluate the diagnosis, treatment and overall approach to managing nosocomial infection in ECLS patients.
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To use a geographic information system to qualitatively and quantitatively illustrate the geospatial relationship of the Australian population to intensive care resources. ⋯ The distribution of Australian ICUs and the Australian population was similar. However, accessibility varied by state/territory.
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Epidemiology and clinical trials require valid, repeatable definitions that ideally dichotomise patients into having, or not having, a clinical condition. • Some conditions are clearly dichotomous, such as pregnancy; others such as hypertension or obesity rely on defining a threshold on an objective scale. • Defining delirium and "adequate" sedation and analgesia in the intensive care unit is more difficult, as there is no universally agreed scale that quantifies the relative importance of various diagnostic features, distinguishes features merely observed from those actively sought, quantifies severity or fluctuation over time, or accounts for the variable approaches of clinicians and the effects of assessment environment and pharmacological treatment. Definitions of delirium and adequate sedation and analgesia therefore vary by assessment method and context, making studies using different methods and personnel not necessarily comparable. • Although there is no simple solution, we suggest better awareness of these problems will be helpful. Further, we propose a simplified categorisation to facilitate clinical communication and treatment in the ICU.
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Intensive care unit liaison nurses (ICULNs) represent a new clinical service role in the Australian health care system. These nurses aim to improve patient outcomes by providing a specialised support service to ward staff caring for acutely ill patients. As this role is relatively new, it is not known how many hospitals employ ICULNs or what the demand for their services is. ⋯ The demand for ICULN services has increased in most hospitals since the role was adopted, although this varies considerably. The majority of patients are reviewed after ICU discharge. Further research is needed to define the scope of practice of the role and its impact on patient outcome, particularly in patients after ICU discharge.
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Liver transplantation is a major life-saving procedure, and donation after cardiac death (DCD) has increased the pool of potential liver donors. However, DCD livers are at increased risk of primary graft dysfunction and biliary tract ischaemia. ⋯ Using extracorporeal membrane oxygenation, parenteral nutrition, separate hepatic artery and portal vein perfusion, and physiological perfusion pressures, we achieved NELP and evidence of function (bile production, paracetamol removal, maintenance of normal ammonia and lactate levels) for 4 hours in pig livers subjected to 15 and 30 minutes of cardiac arrest before explantation. Our experiments justify further investigations of the feasibility and efficacy of human DCD liver preservation by ex-vivo perfusion.