Crit Care Resusc
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To determine the attitudes of critical care clinicians in Australia and New Zealand towards fever management for critically ill patients with sepsis but without neurological injury. ⋯ There is considerable variability in attitudes to fever management with a reported tendency to act to reduce fever in febrile patients with sepsis. There was broad support for a clinical trial of fever management.
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Fluid resuscitation with saline in severe sepsis is controversial. Hypertonic (3%) saline (HTS) may be superior to normal (0.9%) saline (NS). ⋯ In gram-negative sepsis, bolus resuscitation with HTS and NS have similar and transient systemic and regional haemodynamic effects, but no effects on renal perfusion and only short-lived effects on renal function. These findings challenge the physiological rationale for fluid bolus resuscitation in sepsis.
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The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is emerging as the most frequently used tool for identifying delirium among critically ill patients. ⋯ In our hospital, the CAM-ICU detected delirium less often than unstructured delirium assessments made by qualified intensive care nurses.
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Medication errors can be dangerous and are an intensive care unit quality indicator. Few studies have assessed interventions aimed at improving prescription practice. Anecdotal reports in our ICU indicated a high incidence of prescription errors, including illegible handwriting, and lack of prescriber identity and antibiotic indications. Knowledge translation (KT) is an emerging tool that uses collaborative stakeholder participation and focuses on education and inclusiveness rather than punitive audits. ⋯ A systematic KT process of collaborative education can reduce ICU prescription errors.