Crit Care Resusc
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Review
Restrictive red blood cell transfusion strategies in critical care: does one size really fit all?
Many intensive care patients receive red blood cell transfusions. International clinical practice has recently changed, with a decrease in the "trigger" haemoglobin concentration used for red blood cell transfusions in critically ill patients. This change has been driven by increasing awareness of the infectious and non-infectious complications of allogeneic red blood cell transfusion, the perennial blood supply shortages, and most importantly by the Transfusion Requirements in Critical Care (TRICC) study, which suggested that a restrictive transfusion strategy (a transfusion trigger of 70 g/L and a post-transfusion goal of 70-90 g/L) may be equivalent to a liberal transfusion strategy (a transfusion trigger of 100 g/L and a posttransfusion goal of 100-120 g/L) in non-shocked ICU patients. ⋯ Despite this, and a number of important methodological issues that limit the generalisation of the TRICC results to patients with ischaemic heart disease, the TRICC authors, subsequent guidelines and recent reviews have recommended a restrictive strategy in ICU patients with ischaemic heart disease. This conclusion and the change in clinical practice that followed these publications are premature. In determining the appropriate trigger for transfusion of allogeneic blood, the physician should ideally weigh the risk-benefit profile for each individual patient, for each unit of blood administered.
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To determine the effect an intensive care unit liaison nurse service had on ICU patient discharges, readmissions and outcomes. ⋯ The introduction of our ICU liaison nurse service was associated with a trend towards more efficient ICU discharges (increased throughput, decreased ICU step-down days and ICU readmission LOS) and improved survival for ICU patients requiring readmission, but overall ICU and hospital LOS and mortality, and ICU readmission rates were unchanged.
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To investigate the resources and infrastructure available for collecting intensive care unit data in New South Wales for submission to the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD). ⋯ It appears that NSW ICUs are generally not adequately resourced or organised for collecting data, which could significantly affect the quality of data submitted to the ANZICS APD. Further investigation of data quality is warranted, and a follow-up survey of ICU directors is planned. Until the issue of data quality is adequately addressed, outcomes measurement based on these data should be treated with caution.
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To examine practice patterns and workload of practising Australian intensivists and to investigate the risk and prevalence of "burnout syndrome". ⋯ Intensivists are at high risk of burnout syndrome. Recognising the drivers and early signs of burnout and identifying a preventive strategy is a professional priority for ANZICS and the intensive care community.
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A 14-year-old boy with catecholamine-induced polymorphic ventricular tachycardia was treated for hypoxic brain injury after a 25-minute ventricular tachycardia arrest. He had been treated by the local paediatric cardiology service with ?-blockers for syncopal events related to episodes of ventricular tachycardia. ⋯ PtO2 is a reliable and effective clinical assessment tool that can aid in the management of patients with significant cerebral injury. Vasopressin proved a valuable adjunct in treatment of hypoxic brain injury when inotropic agents were contraindicated.