Crit Care Resusc
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Recent research suggests an association between the development of acute lung injury (ALI) and mechanical ventilation with tidal volumes > 6mL per kg of predicted body weight (BW). Specific subgroups (women and obese patients) may be at risk of unintentional delivery of excessive tidal volumes. We conducted a prospective audit of delivered tidal volumes (mL/kg) calculated using recorded BW and compared these to volumes calculated using predicted BW. ⋯ Predicted BW was significantly less than recorded BW. Consequently, larger tidal volumes were delivered on a mL/kg basis when calculated using predicted BW than recorded BW. This was particularly so for women, who received higher volumes than men when using predicted BW. Calculating predicted BW using demispan as a surrogate marker of height is a cheap, easy and noninvasive tool for clinical assessment; its use in the ICU may result in the delivery of more appropriate tidal volumes.
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The Royal Children's Hospital, Melbourne, Victoria, provides extracorporeal life support (ECLS) for infants and children from all around Australia. Since 2003, we have offered a mobile ECLS service to retrieve critically ill children whose condition is too unstable for conventional transport. The retrieval team comprises a paediatric intensive care unit specialist, an ECLS nurse specialist, a perfusionist and a cardiac surgeon. ⋯ This is the first report of ECLS transport in Australia. In our experience, children who would not otherwise be transportable can be safely transported long distances on ECLS, and should be offered this if appropriate resources exist. However, this approach should not replace the timely referral of patients who are likely to need ECLS.
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A 40-year old Indigenous woman with a history of mitral valve replacement was admitted to the Royal Darwin Hospital, Northern Territory, for an elective cone biopsy of the cervix. During the admission, she had recurrent fever and joint pain of the left knee. ⋯ Abiotrophia defectiva was identified from the culture, and a transoesophageal echocardiogram revealed endocarditis of the mitral valve prosthesis. A review of the English-language literature suggests that this is the first reported case of Abiotrophia endocarditis in Australia, and the third reported case of prosthetic-valve endocarditis caused by this species worldwide.
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A number of recent therapeutic advances have resulted from basic science research. With the change in medical education and practice towards evidence-based medicine, we wished to determine the role of basic science research in Australian intensive care practice. We believe this is the first survey of Australian intensivists and trainees to assess the influence of basic science research on their clinical duties. We discuss the importance and influence of basic science in intensive care practice and the development of postgraduate appreciation of basic science, highlight the impact of some of the changes in medical education on basic science undergraduate teaching, and discuss the clinical applicability and current participation in basic science research. ⋯ Critical care practitioners consider basic science research to be relevant and important to their practice. There is interest in clinically applicable basic science research, but few people regularly review basic science articles at journal clubs. Reassuringly, participation in basic science research increases throughout intensive care training, despite changes in medical education and lack of protected time for research.
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To assess current practice in acute stress ulceration (ASU) prophylaxis in adult intensive care units in Victoria, Australia, in 1997 and 2005. ⋯ Use of ASU prophylaxis for patients admitted to Victorian ICUs increased significantly from 1997 to 2005, with an associated increase in the presence of protocols or guidelines for ASU prophylaxis. Although agents currently used for ASU prophylaxis in Victorian ICUs are consistent with available evidence, we are concerned that ASU prophylaxis is given to all patients admitted to the ICU rather than targeted to patients in high-risk categories.