Crit Care Resusc
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Recently there has been increased focus on improved detection and management of deteriorating patients in Australian hospitals. Since the introduction of the medical emergency team (MET) model there has been an increased role for intensive care unit staff in responding to deterioration of patients in hospital wards. Review and management of MET patients differs from the traditional model of ward patient review, as ICU staff may not know the patient. ⋯ In this article we briefly review the principles of the MET and contend that activation of the MET by ward staff represents a response to a medical crisis. We then outline why MET intervention differs from traditional ward-based doctor-patient encounters, and emphasise the importance of non-technical skills during the MET response. Finally, we suggest ways in which the skills required for crisis resource management within the MET can be taught to ICU staff, and the potential benefits, barriers and difficulties associated with the delivery of such training in New Zealand and Australia.
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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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Comparative Study Clinical Trial
Near-infrared spectroscopy of the thenar eminence: comparison of dynamic testing protocols.
Near-infrared spectroscopy of the thenar eminence (NIRSth) is a non-invasive bedside method for assessing tissue oxygenation. The vascular occlusion test (VOT) with a pressure cuff can be used to provide a dynamic assessment of the tissue oxygenation response to ischaemia. VOT has been applied to assess the microcirculation by NIRSth in critically ill patients. The optimal mode of performing such VOT, however, remains controversial. ⋯ The 3-minute VOT and the 40% StO(2) appear equivalent. However, the 3-minute VOT carries a degree of decreased patient discomfort and shorter overall duration of execution.