The biochemical effects of restricting chloride-rich fluids in intensive care.

Objective: To determine the biochemical effects of restricting the use of chloride-rich intravenous fluids in critically ill patients.

Design: Prospective, open-label, before-and-after study.

Setting: University-affiliated intensive care unit.

Features and outcome of patients receiving multiple Medical Emergency Team reviews.

Background And Objectives: There is no information on the clinical features and outcome of patients receiving multiple Medical Emergency Team (MET) reviews. Accordingly, we studied the characteristics and outcome of patients receiving one MET call and compared them with those receiving multiple MET reviews.

Design: Retrospective observational study using prospectively collected data.

Life-threatening respiratory failure from H1N1 influenza 09 (human swine influenza).

We present the first six cases of H1N1 influenza 09 (confirmed by a polymerase chain reaction test from nasopharyngeal swabs) in patients requiring admission to intensive care in Australia (in three hospitals in the north-western suburbs of Melbourne). These cases highlight the small but significant risk of life-threatening respiratory failure associated with H1N1 influenza 09 infection.

Decreased catecholamine degradation associates with shock and kidney injury after cardiac surgery.

Enzymatic pathways involving catechol-O-methyltransferase (COMT) catabolize circulating catecholamines. A G-to-A polymorphism in the fourth exon of the COMT gene results in a valine-to-methionine amino acid substitution at codon 158, which leads to thermolability and low ("L"), as opposed to high ("H"), enzymatic activity. We enrolled 260 patients postbypass surgery to test the hypothesis that COMT gene variants impair circulating catecholamine metabolism, predisposing to shock and acute kidney injury (AKI) after cardiac surgery.

Interventions to circumvent intensive care access block: a retrospective 2-year study across metropolitan Melbourne.

Objectives: To measure the prevalence of interventions used to circumvent intensive care access block and to estimate the attributable mortality and additional hospital bed-days associated with them.

Design And Setting: Retrospective observational study of 11 adult public hospital intensive care units (ICUs) in Melbourne, Victoria, July 2004 - June 2006.

Main Outcome Measures: Prevalence of five interventions in response to access block; attributable fatalities and/or increased length of stay associated with each.

Post-hypoxic myoclonic status: the prognosis is not always hopeless.

A 67-year-old woman abruptly developed acute pulmonary oedema, severe bradycardia and then cardiac arrest while in hospital 6 days after an elective hernia repair. She was resuscitated, intubated and transferred to the intensive care unit. Within 24 hours, she began to display repetitive, generalised myoclonic jerks that failed to respond to therapy with conventional anticonvulsants; an electroencephalogram confirmed myoclonic status.

Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up.

Objective: To compare the safety, availability, and long-term sequelae of percutaneous vs. surgical tracheostomy.

Design: Prospective, randomized, controlled study.

Circadian pattern of activation of the medical emergency team in a teaching hospital.

Introduction: Hospital medical emergency teams (METs) have been implemented to reduce cardiac arrests and hospital mortality. The timing and system factors associated with their activation are poorly understood. We sought to determine the circadian pattern of MET activation and to relate it to nursing and medical activities.

Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.

Background: Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest.