Crit Care Resusc
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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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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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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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Misdiagnosis of the cause of illness in critically ill patients is common, and a major cause of morbidity and mortality. We reflect upon a misdiagnosis that occurred in the intensive care unit of a metropolitan teaching hospital, and highlight the susceptibility of medical decision making to error. ⋯ We discuss the vulnerability of such processes and - with particular reference to our case - why even knowledgeable and diligent clinicians are prone to misdiagnose. Finally, we review potential solutions, both educational and systemic, that may guard against the inevitable failings of the human mind, especially in a busy modern intensive care setting.
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There is uncertainty about which end points should be used for Phase II trials in critically ill patients. ⋯ The consensus panel concluded that there are no adequately validated end points for Phase II trials in critically ill patients. However, the following were identified as potential Phase II end points: hospital-free days to Day 90, ICU-free days to Day 28, ventilator-free days to Day 28, cardiovascular support-free days to Day 28, and renal replacement therapy-free days to Day 28. We recommend that these end points be evaluated further.