Crit Care Resusc
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Review
Informed consent for procedures in the intensive care unit: ethical and practical considerations.
There is increasing interest in procedural consent (informed consent for invasive procedures) in the intensive care unit. We reviewed studies of procedural consent and show that it is not yet routine practice to obtain consent before performing invasive procedures on ICU patients. We considered logistical barriers to procedural consent in the critical care environment and the ethical implications of introducing routine procedural consent to the ICU.
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To determine the accuracy of multidetector computed tomography (MDCT) in the diagnosis of nonocclusive mesenteric ischaemia (NOMI) among patients after cardiovascular surgery. ⋯ MDCT has high sensitivity but lacks specificity in the diagnosis of NOMI. Its main value is in selection of patients for non-operative management, at least in the short-to-medium term.
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To determine the influence of vascular access site on continuous renal replacement therapy (CRRT) filter survival. ⋯ Vascular access for CRRT plays a significant role in determining filter life. Our study suggests that for temporary dialysis catheters the femoral site should be favoured in ICU patients, and if CRRT is likely to continue for an extended period, a tunnelled IJ line should be considered.
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To examine self-reported treatment preferences among Australasian consultant intensivists for intensive care-acquired hypernatraemia (IAH). ⋯ There is a wide variety of treatments in use for IAH. Most clinicians initiate treatment at a level greater than the level that is independently associated with increased mortality in the literature.1 Initial treatment is equally divided between changes in intravenous fluid and changes in enteral nutrition.
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The model currently used in public hospitals in Australia and New Zealand - of closed, mixed medical-surgical ICUs, led by consultant intensivists who remain in charge but collaborate closely across multiple specialties and disciplines and are supported by well trained junior medical staff- is internationally admired and has provided cost-effective care. Careful workforce planning is essential to ensure that intensivists retain their identity and that an efficient model persists into the future.