Crit Care Resusc
-
Intensive care patients with traumatic brain injury (TBI) are at high risk of developing deep vein thrombosis (DVT). A high rate of DVT was reported before routine thromboprophylaxis, but the current DVT rate in TBI patients receiving best-practice mechanical and pharmacological prophylaxis is unknown. ⋯ Mechanical and pharmacological prophylaxis appeared to be effective. The incidence of clinically identified PE is of concern and suggests that thromboembolic sources other than large leg veins may not be being adequately controlled by modern thromboprophylaxis regimens.
-
Recommended daily intake of sodium is 1- 2mmol/kg. Sodium administration is rarely separated from fluid administration in critically ill patients. ⋯ Sodium administration to this cohort of critically ill patients requiring prolonged mechanical ventilation was high. Further studies should examine ways of limiting the amount of sodium administered to such patients and to examine if this influences patient outcomes.
-
To compare registrar sleep and supervision hours before and after a change in roster to accommodate more senior registrar (SR) positions, and to identify risky patterns of sleep on night shifts. ⋯ Changing the registrar roster to meet the training demands of our senior trainees did not adversely affect registrar sleep or supervision. Registrars may be taking on unnecessary risk due to poor sleep hygiene around night shifts. We suggest sleep education and scheduled sleep time during night shifts.
-
Respiratory complications following cervical spinal cord injury are common and are the leading cause of morbidity and mortality after this type of injury. Impaired mechanics of ventilation, poor cough, increased secretions and bronchospasm predispose to atelectasis, pneumonia and exacerbations of respiratory failure. Prolonged mechanical ventilation and tracheostomy are often required. This review discusses the relevant pathophysiology, various ventilatory strategies and timing of tracheostomy, and examines the evidence surrounding physiotherapeutic and pharmacological treatment options.
-
Paracetamol is one of the commonest medications used worldwide. This review was conceived as a consequence of evaluating the literature in the protocol development of two randomised, controlled clinical trials investigating the safety and efficacy of paracetamol in ICU patients (the HEAT [Permissive HyperthErmiA Through Avoidance of Paracetamol in Known or Suspected Infection in the Intensive Care Unit] study; the Paracetamol After traumatic Brain Injury [PARITY] Study). ⋯ Despite the widespread use of paracetamol in critical illness, there is a paucity of data supporting its utility in this setting. Further research is required to determine how paracetamol should be used in the critically ill.