Crit Care Resusc
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The imprecision in prescribing of enteral nutrition in critically ill patients must result in occasions of overfeeding as well as underfeeding. Overfeeding could cause increased CO2 production and thus increased work of breathing and prolonged ventilator dependence. ⋯ Patients in the energy-dense feeding arm will receive 50% more calories and produce 52% more CO2 than patients in the standard feeding arm. The full TARGET study is ideally positioned to answer the practical clinical question of whether increased feeding in critically ill patients can be delivered without prolonging ventilator dependence.
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Anecdotal reports about bullying behaviour in intensive care emerged during College of Intensive Care Medicine (CICM) hospital accreditation visits. Bullying, discrimination and sexual harassment (BDSH) in the medical profession, particularly in surgery, were widely reported in the media recently. This prompted the College to formally survey its Fellows and trainees to identify the prevalence of these behaviours in the intensive care workplace. ⋯ The occurrence of BDSH appears to be common in the intensive care environment in Australia and New Zealand.
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Cerebral protection is a key priority during cardiac arrest (CA). However, current approaches are suboptimal. ⋯ During experimental CA, cerebral perfusion and cooling are possible by means of an ECMO circuit connected to the anterior cerebral circulation. Antegrade perfusion appears to be superior. Further investigations of the antegrade perfusion technique appear justified.
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Several biological markers can predict outcomes in patients with subarachnoid haemorrhage (SAH), but markers to predict neurological deficit severity in patients with SAH and poor neurological condition have not yet been established. Soluble CD40 ligand (sCD40L) and platelet-derived growth factor (PDGF) are related to the systemic inflammatory response. ⋯ Our data suggest that sCD40L, PDGF-BB, WBC count, CRP and body temperature can predict the neurological outcome in patients with SAH and poor neurological condition.
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Rapid response team (RRT) responders would benefit from training, to ensure competent and efficient management of the deteriorating patient. ⋯ There was unanimous agreement by participants for further development of a formalised RRT training course for responding to the deteriorating patient. Participants who were RRT educators also supported the development of an RRT train-the-trainer course.