Crit Care Resusc
-
Patients who recover from critical illness may be left with significant limitations to their physical function that can have important consequences for their quality of life. Measures of physical function may be useful end points to consider in studies conducted in critically ill patients and are particularly attractive in studies investigating early mobilisation and rehabilitation. ⋯ A wide range of end points have been used to evaluate physical function in critically ill patients. However, further studies are needed to establish the measurement properties of the most commonly used end points in order to recommend their use in clinical trials.
-
A systematic review to examine the safety and efficacy of ultrasound before and/or during percutaneous dilatational tracheostomy (PDT). ⋯ There are currently no randomised controlled trials to establish the safety or efficacy of preprocedural and/or real-time intraprocedural ultrasound guidance during PDT compared with the current standard of care. One study supports the use of real-time ultrasound guidance during PDT in preventing cranial tracheostomy tube misplacement. Observational data suggest that preprocedural ultrasound may help prevent vascular complications and that real-time ultrasound guidance during PDT is likely safe, with a high success rate. A prospective randomised controlled trial evaluating its safety and efficacy compared with the traditional landmarkguided technique is required to establish its role in clinical practice.
-
Paracetamol is commonly administered to febrile critically ill patients with infection. However, there is limited information on the efficacy and safety of using paracetamol in this setting. We describe the study protocol for a Phase IIb multicentre randomised controlled trial (the Permissive Hyperthermia Through Avoidance of Paracetamol in Known or Suspected Infection in ICU [HEAT] trial) comparing intravenous paracetamol to placebo in the treatment of fever in critically ill adults with known or suspected infection. ⋯ The HEAT trial should generate results that will inform and influence the prescribing of paracetamol. It will also determine if a large-scale Phase III trial of paracetamol is required in this patient group and whether such a trial is feasible.
-
Multicenter Study
Patients admitted to Australian intensive care units: impact of remoteness and distance travelled on patient outcome.
To use a geographical information system (GIS) to explore the impact of (i) patient remoteness and (ii) distance travelled to an Australian public-hospital intensive care unit on patient outcomes. ⋯ For patients who were admitted to the ICU after being transferred from another hospital, greater remoteness and greater distance travelled were not associated with increased mortality, but LOS in the hospital and the ICU was longer.
-
To determine the incidence, risk factors and impact of ventilator-associated pneumonia (VAP) in a mixed tertiary paediatric intensive care unit. ⋯ VAP in children is associated with significant morbidity and increased length of hospital stay. Enteral feeding and stress ulcer prophylaxis while intubated are associated with lower VAP hazards.