Crit Care Resusc
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Observational Study
Service delivery model of extracorporeal membrane oxygenation in an Australian regional hospital.
The role of extracorporeal membrane oxygenation (ECMO) for adults in regional centres with low numbers of patients receiving ECMO is unclear. A robust service delivery model may assist in the quality provision of ECMO. ⋯ Provision of ECMO in a tertiary regional hospital within a multifaceted clinical service model is feasible and safe. Partnership with a centre providing ECMO for a high number of patients during service development and delivery is desirable.
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Multicenter Study
Early experience of a new extracorporeal carbon dioxide removal device for acute hypercapnic respiratory failure.
Recent advances in the technology of extracorporeal respiratory assist systems have led to a renewed interest in extracorporeal carbon dioxide removal (ECCOR). The Hemolung is a new, low-flow, venovenous, minimally invasive, partial ECCOR device that has recently been introduced to clinical practice to aid in avoiding invasive ventilation or to facilitate lung-protective ventilation. ⋯ Our data shows that ECCOR was safe and effective in this cohort. Further experience is vital to identify the patients who may benefit most from this promising therapy.
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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.