Crit Care Resusc
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Case Reports
Independent lung ventilation in the intensive care unit: desperate measure or viable treatment option?
Independent lung ventilation is often used intra-operatively but has also been used in intensive care in a variety of clinical situations. Ventilating lungs independently of each other may be life-saving when a lung abnormality is predominantly unilateral. We successfully used independent lung ventilation in two patients, who benefited from anatomical and physiological separation of their lungs. These cases remind intensivists that independent lung ventilation is a viable option to be considered in cases of pulmonary abnormality when conventional mechanical ventilation is deleterious.
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Multicenter Study
Terror Australis 2004: preparedness of Australian hospitals for disasters and incidents involving chemical, biological and radiological agents.
To assess the level of preparedness of Australian hospitals, as perceived by senior emergency department physicians, for chemical, biological and radiological (CBR) incidents, as well as the resources and training available to their departments. ⋯ This survey raises significant questions about the level of preparedness of Australian EDs for dealing with patients from both conventional and CBR incidents. Hospitals need to review their plans and functionality openly and objectively to ensure that their perceived preparedness is consistent with reality. In addition, they urgently require guidance as to reasonable expectations of their capacity. To that end, we recommend further development of national standards in hospital disaster planning and preparedness.
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Comparative Study
Hypothermia on arrival in the intensive care unit after surgery.
Minimising perioperative hypothermia is a priority for anaesthetists. However, there are few studies of postoperative hypothermia in intensive care units. We tested the hypotheses that many patients arrive in the ICU with hypothermia and that patients are warmer after cardiac surgery than after non-cardiac surgery. ⋯ Hypothermia is common among postoperative patients admitted to our ICU. We suggest that ICU staff should routinely expect to actively warm postoperative patients, particularly after non-cardiac surgery, and should have sufficient resources to do so.
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It is often assumed that critical care outcomes in the elderly are uniformly poorer than those in younger populations. We examined the pattern of admissions to our intensive care unit in Dublin, Ireland, between 2002 and 2005 to determine the admission characteristics and mortality in those aged 80 years and older. ⋯ The nature of the admission and severity of illness, but not age, are determinants of ICU survival. Evidence-based criteria are needed to assess the appropriateness of ICU admission in the very elderly. Clear criteria would help to prevent initiation of futile therapies and also to ensure that the very elderly are not denied potentially beneficial ICU care. We need to study triage patterns and outcome data further to ensure that the very elderly have the same opportunities to access appropriate intensive care treatment as the rest of the population.