Crit Care Resusc
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Clinical Trial
Prospective observational study of levosimendan and weaning of difficult-to-wean ventilator dependent intensive care patients.
To evaluate the role of levosimendan in improving cardiac performance and the success rate of weaning from mechanical ventilation in ventilatordependent, difficult-to-wean patients with impaired cardiac function in the intensive care unit. ⋯ Levosimendan may provide significant benefit to ventilator-dependent patients with impaired left ventricular function. Randomised controlled trials appear justified.
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Clinical Trial
Implementation and outcomes of a severe sepsis protocol in an Australian tertiary hospital.
To evaluate the effect of implementation of a sepsis protocol. ⋯ Implementation of a sepsis protocol led to a change in the delivery of care with no reduction in mortality in patients with severe sepsis and septic shock admitted to a Level III ICU in a tertiary hospital.
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There is evidence that intensive glycaemic control decreases morbidity and mortality in surgical intensive care unit patients. In traumatic brain injury, hyperglycaemia is a prognostic indicator. ⋯ The intensive insulin protocol was effective in lowering blood glucose in neurosurgical ICU patients.
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Multicenter Study
Renal replacement therapy for acute kidney injury in Australian and New Zealand intensive care units: a practice survey.
There are few published data on the practice of renal replacement therapy (RRT) in Australian and New Zealand intensive care units. These data are essential for designing trials to compare new treatment approaches with "standard care". ⋯ These findings provide insight into RRT practice in ICUs in Australia and New Zealand, as well as useful data to assess whether the control group in the RENAL trial receives "standard" therapy as delivered in Australian and New Zealand trial centres at the time.
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Review
Review of the application of risk-adjusted charts to analyse mortality outcomes in critical care.
This review describes the methods for displaying riskadjusted mortality data for critical care units. Two applications are considered. The comparison within a cohort of risk-adjusted mortality performance uses standardised mortality ratios (SMRs), league tables, caterpillar plots and funnel plots. ⋯ The relative merits of different methods are discussed. Risk-adjusted monitoring plays a role in the context of a holistic quality development strategy. The importance of a planned approach to response and intervention is stressed.