Meropenem-induced vanishing bile duct syndrome: A case report.

Vanishing bile duct syndrome (VBDS) refers to a group of acquired disorders associated with progressive destruction and disappearance of the intrahepatic bile ducts. We report a case of meropenem-induced VBDS in a patient who had undergone surgical repair of a ruptured abdominal aortic aneurysm. Meropenem was used to treat isolated from blood, urine, sputum, and wound swab cultures.

A practice survey of airway management in Australian and New Zealand intensive care units.

Objective: To characterise intubation practices in Australian and New Zealand intensive care units (ICUs) and investigate clinician support for establishing airway management guidelines in Australian and New Zealand ICUs.

Design: An online survey was designed, piloted and distributed to members of the mailing list of the Australian and New Zealand Intensive Care Society (ANZICS), with medical members invited to participate. Respondents were excluded if their primary practice was in paediatric ICUs.

How do intensivists treat their patients, their loved ones and themselves? Results of a survey of intensivists facing an evolving hypothetical clinical scenario.

Aim: Prognostication and decisions regarding ineffectiveness of treatment remain challenging for clinicians and are some of the most difficult yet understudied aspects of clinical medicine. We sought to explore what management intensivists would advocate for a patient, for themselves or for a loved one at different points in an evolving hypothetical clinical scenario of a critically ill patient admitted to the intensive care unit (ICU).

Method: An online survey was constructed and was circulated to fellows of the College of Intensive Care Medicine (CICM) of Australia and New Zealand.

Association of Hypercapnia and Hypercapnic Acidosis With Clinical Outcomes in Mechanically Ventilated Patients With Cerebral Injury.

Importance: Clinical studies investigating the effects of hypercapnia and hypercapnic acidosis in acute cerebral injury are limited. The studies performed so far have mainly focused on the outcomes in relation to the changes in partial pressure of carbon dioxide and pH in isolation and have not evaluated the effects of partial pressure of carbon dioxide and pH in conjunction.

Objective: To review the association of compensated hypercapnia and hypercapnic acidosis during the first 24 hours of intensive care unit admission on hospital mortality in adult mechanically ventilated patients with cerebral injury.

Proportional assist ventilation versus pressure support ventilation in weaning ventilation: a pilot randomised controlled trial.

Objective: Proportional assist ventilation with load-adjustable gain factors (PAV+) is a mode of ventilation that provides assistance in proportion to patient effort. This may have physiological and clinical advantages when compared with pressure support ventilation (PSV). Our objective was to compare these two modes in patients being weaned from mechanical ventilation.

The outcome of patients with severe and severe-complicated Clostridium difficile infection treated with tigecycline combination therapy: a retrospective observational study.

Background: Tigecycline is a third-line therapy for severe Clostridium difficile infection (CDI) in Australasian guidelines. Differences in strain types make it difficult to extrapolate international tigecycline efficacy data with combination or monotherapy to Australian practice, where experience is limited.

Aim: To evaluate the efficacy and adverse effects associated with tigecycline combination therapy for severe and severe-complicated CDI in an Australian healthcare setting.

Effects of Hypercapnia and Hypercapnic Acidosis on Hospital Mortality in Mechanically Ventilated Patients.

Objectives: Lung-protective ventilation is used to prevent further lung injury in patients on invasive mechanical ventilation. However, lung-protective ventilation can cause hypercapnia and hypercapnic acidosis. There are no large clinical studies evaluating the effects of hypercapnia and hypercapnic acidosis in patients requiring mechanical ventilation.

Early experience of a new extracorporeal carbon dioxide removal device for acute hypercapnic respiratory failure.

Background: Recent advances in the technology of extracorporeal respiratory assist systems have led to a renewed interest in extracorporeal carbon dioxide removal (ECCOR). The Hemolung is a new, low-flow, venovenous, minimally invasive, partial ECCOR device that has recently been introduced to clinical practice to aid in avoiding invasive ventilation or to facilitate lung-protective ventilation.

Objective: We report our early experience on use, efficacy and safety of the Hemolung in three Australian intensive care units.

Imatinib for bleomycin induced pulmonary toxicity: a case report and evidence-base review.

The evidence supporting therapy with imatinib for bleomycin-induced pneumonitis (BIP) is equivocal. Further experience is needed to establish its role in BIP management. While it may be considered in the management of BIP, it is important to be mindful of the adverse effects including thrombocytopenia and gastrointestinal bleeding.

Heparin induced thrombocytopenia in critically ill: Diagnostic dilemmas and management conundrums.

Thrombocytopenia is often noted in critically ill patients. While there are many reasons for thrombocytopenia, the use of heparin and its derivatives is increasingly noted to be associated with thrombocytopenia. Heparin induced thrombocytopenia syndrome (HITS) is a distinct entity that is characterised by the occurrence of thrombocytopenia in conjunction with thrombotic manifestations after exposure to unfractionated heparin or low molecular weight heparin.

Intravenous amino acid therapy for kidney function in critically ill patients: a randomized controlled trial.

Importance: Acute kidney injury (AKI) is characterized by severe loss of glomerular filtration rate (GFR) and is associated with a prolonged intensive care unit (ICU) stay and increased risk of death. No interventions have yet been shown to prevent AKI or preserve GFR in critically ill patients. Evidence from mammalian physiology and small clinical trials suggests higher amino acid intake may protect the kidney from ischemic insults and thus may preserve GFR during critical illness.

The Outcome and Predictors of Mortality in Patients Therapeutically Cooled Postcardiac Arrest.

Purpose: To review the outcomes of patients postcardiac arrest admitted to a metropolitan intensive care unit (ICU) where therapeutic hypothermia is practiced.

Materials And Methods: Patients admitted from 2004 to 2012 were reviewed. The management protocol included cooling to 33°C for 24 hours.

Low-flow veno-venous extracorporeal carbon dioxide removal in the management of severe status asthmatics: a case report.

Status asthmaticus is a life-threatening condition that requires intensive care management. Most of these patients have severe hypercapnic acidosis that requires lung protective mechanical ventilation. A small proportion of these patients do not respond to conventional lung protective mechanical ventilation or pharmacotherapy.

Diaphragmatic regional displacement assessed by ultrasound and correlated to subphrenic organ movement in the critically ill patients--an observational study.

Introduction: The objectives of the study are to identify the most reliably imaged regions of the diaphragm, to evaluate the correlation of movement between different parts of each hemidiaphragm, and to assess the agreement between liver or spleen displacement and movement of the ipsilateral hemidiaphragm.

Methods: Images of the diaphragm, liver, and spleen were obtained using 2-dimensional ultrasound. Acceptable agreement between regions of the diaphragm, liver, and spleen was defined as an absence of fixed or proportional bias using Deming regression analysis and limits of agreement of 2 SDs of the difference less than 30% of the mean value.

Is cooling still cool?

Therapeutic hypothermia (TH), where patients are cooled to between 32°C and 36°C for a period of 12-24 hours and then gradually rewarmed, may reduce the risk of ischemic injury to cerebral tissue following a period of insufficient blood flow. This strategy of TH could improve mortality and neurological function in patients who have experienced out-of-hospital cardiac arrest (OOHCA). The necessity of TH in OOHCA was challenged in late 2013 by a fascinating and potentially practice changing publication, which found that targeting a temperature of 36°C had similar outcomes to cooling patients to 33°C.

Fatal skin and soft tissue infection of multidrug resistant Acinetobacter baumannii: A case report.

Introduction: Acinetobacter baumannii is usually associated with respiratory tract, urinary tract and bloodstream infections. Recent reports suggest that it is increasingly causing skin and soft tissue infections. It is also evolving as a multidrug resistant organism that can be difficult to treat.

Futility of medical treatment in current medical practice.

Intensive care provides support for acute reversible organ failure and most patients who receive intensive care recover from their illness. In some patients organ failure may become irreversible and in these patients further treatment or organ support may be considered futile. Emerging technologies and expertise can enable the medical profession to prolong life / death indefinitely without curing or controlling the underlying disease process.

Stress hyperglycemia may not be harmful in critically ill patients with sepsis.

Background: Stress hyperglycemia (SH) is commonly seen in critically ill patients. It has been shown to be associated with adverse outcomes in some groups of patients. The effects of SH on critically ill patients with sepsis have not been well studied.

Effectiveness of extracorporeal membrane oxygenation when conventional ventilation fails: valuable option or vague remedy?

The mortality and morbidity of patients with severe acute respiratory distress syndrome (ARDS) remains high despite the advances in intensive care practice. The low-tidal-volume ventilation strategy (ARDS net protocol) has been shown to be effective in improving survival. Unfortunately, however, some patients have such severe ARDS that they cannot be managed with the ARDS net strategy.

Dose-related effect of smoking on mortality in critically ill patients: a multicentre cohort study.

Purpose: It is uncertain whether smoking has an independent dose-related adverse effect on mortality in critically ill patients. This study assessed whether the intensity of smoking history, measured in pack-years, has a dose-related effect on mortality in critically ill patients.

Methods: In this multicentre cohort study data were collected from six tertiary intensive care units (ICU) in Australia and New Zealand.

Hypothermia predicts mortality in critically ill elderly patients with sepsis.

Background: Advanced age is one of the factors that increase mortality in intensive care. Sepsis and multi-organ failure are likely to further increase mortality in elderly patients.We compared the characteristics and outcomes of septic elderly patients (> 65 years) with younger patients (≤ 65 years) and identified factors during the first 24 hours of presentation that could predict mortality in elderly patients.

End of life management of adult patients in an Australian metropolitan intensive care unit: A retrospective observational study.

Background: Death in the intensive care unit is often predictable. End of life management is often discussed and initiated when futility of care appears evident. Respect for patients wishes, dignity in death, and family involvement in the decision-making process is optimal.

High-flow nasal oxygen vs high-flow face mask: a randomized crossover trial in extubated patients.

Purpose: Oxygen delivery after extubation is critical to maintain adequate oxygenation and to avoid reintubation. The delivery of oxygen in such situations is usually by high-flow face mask (HFFM). Yet, this may be uncomfortable for some patients.