Crit Care Resusc
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To define the relationship between worsening oxygenation status (worst PaO(2)/FiO(2) ratio in the first 24 hours after intensive care unit admission) and mortality in immunosuppressed and immunocompetent ICU patients in the presence and absence of mechanical ventilation. ⋯ Immunosuppression increases the risk of mortality with progressively worsening oxygenation status, but only in the presence of mechanical ventilation. Further research into the impact of mechanical ventilation in immunosuppressed patients is required.
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To determine the impact on call characteristics and patient outcomes since the implementation of a two-tiered rapid-response system along with new observation charts and calling criteria. ⋯ Implementation of a two-tiered rapid-response system and new observation charts and calling criteria increased the number of rapid-response calls with a nonsignificant trend towards a decreased incidence of serious adverse events. Further improvements in care of hospitalised patients may be possible by preventing repeat calls or calls within 24 hours of hospital admission and discharge from acute care areas.
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Case Reports
Two cases of toxic methanol ingestion, one leading to brain death: case reports and a brief review.
Two patients were admitted sequentially to a rural emergency department, then transferred to a tertiary intensive care unit, both with serious methanol poisoning from home-brewed alcohol. They were intubated, mechanically ventilated, and treated with intravenous and nasogastric ethanol and continuous venovenous haemodiafiltration. Although quite similar in presentation, metabolic complications and therapy, one patient became brain dead due to severe cerebral oedema, while the other was discharged without any significant complications. Their course highlights the importance of early treatment of non-ethanol alcohol poisoning.
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Recommended daily intake of sodium is 1- 2mmol/kg. Sodium administration is rarely separated from fluid administration in critically ill patients. ⋯ Sodium administration to this cohort of critically ill patients requiring prolonged mechanical ventilation was high. Further studies should examine ways of limiting the amount of sodium administered to such patients and to examine if this influences patient outcomes.
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To compare registrar sleep and supervision hours before and after a change in roster to accommodate more senior registrar (SR) positions, and to identify risky patterns of sleep on night shifts. ⋯ Changing the registrar roster to meet the training demands of our senior trainees did not adversely affect registrar sleep or supervision. Registrars may be taking on unnecessary risk due to poor sleep hygiene around night shifts. We suggest sleep education and scheduled sleep time during night shifts.