Crit Care Resusc
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Traumatic brain injury (TBI) can result in cerebral oedema and vascular changes resulting in an increase in intracranial pressure (ICP), which can lead to further secondary damage. Decompressive craniectomy (DC) is a surgical option in the management of ICP. We aimed to investigate outcomes of DC after TBI. ⋯ DC decreased ICP postoperatively. The IMPACT and APACHE II scores are good models for prediction of death and poor outcome at 6 months.
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Low tidal volume ventilation (LTVV) has been shown to reduce mortality of patients with acute lung injury (ALI) but uptake by clinicians has been low. Recent studies have shown that LTVV results in survival benefit at 24 months after discharge and, importantly, benefits patients without ALI. ⋯ Adherence to LTVV in a general cohort of ICU patients was low, but it was better in patients with more severe lung disease. Overestimation of PBW may have contributed to our findings. Regular auditing of LTVV adherence might be considered a clinical indicator of good MV practice.
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In the past 5 years, there has been a significant rise in the number of trained and fully qualified specialists in intensive care medicine. Recent concerns about saturation of specialist employment opportunities and the prospect of new Fellows unable to find appropriate employment after completion of training has brought intensive care workforce issues to the forefront. The board members of the College of Intensive Care Medicine (CICM) and Australia and New Zealand Intensive Care Society (ANZICS) held the Intensive Care Workforce Summit with presidents of other medical colleges, government officials and legal experts. ⋯ Recent changes to the selection process for new trainees have had a dramatic impact on the number of new trainees in 2014 but the enduring effect of this is yet to be determined. The group discussed potential growth areas for employment of intensive care consultants, including changes in employment patterns and also the impact of reduced numbers of trainees on unit staffing. CICM and ANZICS have agreed to continue to monitor and discuss the situation on a regular basis.