Mechanical Circulatory support for Septic Shock in Children and Adults: Different but Similar!

Whilst Extra-Corporeal Membrane Oxygenation (ECMO) for circulatory support in patients with severe septic shock, commenced in newborn infants and children in the late 1980's, ECMO has remained a controversial treatment for adults with refractory septic shock (RSS). This is fundamentally due to differences in the predominant hemodynamic response to sepsis. In newborn infants and very young children ventricular failure called Low Cardiac Output Syndrome (LCOS) is the major hemodynamic response whilst adolescents and adults have mainly vasoplegic shock.

Staff experiences, perceptions of care, and communication in the intensive care unit during the COVID-19 pandemic in Australia.

Background: In 2020, during the first wave of the COVID-19 pandemic in Australia, hospital intensive care units (ICUs) revised patient care practices, curtailed visiting, and augmented the use of personal protective equipment to protect patients, staff, and the community from viral transmission.

Aim: The aim was to explore ICU staff experiences and perceptions of care and communication with patients during the COVID-19 pandemic to understand how alternative ways of working have influenced work processes, relationships, and staff morale.

Methods: This was a qualitative exploratory design study using audio-recorded and transcribed interviews with 20 ICU staff members.

Perceptions held by healthcare professionals concerning organ donation after circulatory death in an Australian intensive care unit without a local thoracic transplant service: A descriptive exploratory study.

Background And Objective: Organ donation rates continue to be low in Australia compared with demand. Donation after circulatory death (DCD) has been an important strategy to increase donation rates, facilitated by advances in cardiopulmonary support in intensive care units (ICUs). However, DCD may harbour greater logistical challenges and unfavourable perceptions amongst some ICU healthcare professionals.

A preliminary study of intensivist-performed DVT ultrasound screening in trauma ICU patients (APSIT Study).

Background: Multiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU). Intensive care physician performed compression ultrasound (IP-CUS) has shown promise as a diagnostic test for DVT in a non-trauma setting. Whether IP-CUS can be used as a screening test in trauma patients is unknown.

A Protocol that Mandates Postoxygenator and Arterial Blood Gases to Confirm Brain Death on Venoarterial Extracorporeal Membrane Oxygenation.

The apnea test (AT) during clinical brain death (BD) testing does not account for different arterial gas tensions on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). We aimed to develop a protocol and now report our experience with three patients. The protocol was developed and implemented in 2015 at a quaternary center in Australia, measures both right radial and postoxygenator carbon dioxide (CO2) and oxygen (O2) gas tensions during the AT, incorporates regular gas sampling and a gradual reduction in fresh gas flow to ensure patient oxygenation.

Exploring staff perceptions of organ donation after circulatory death.

Background And Objective: Solid organ donation remains low in Australia; however, donation after circulatory death (DCD) bolsters rates and is associated with good short- and long-term clinical outcomes among recipients, especially in lung and kidney recipients. However, its reintroduction is met with resistance within hospitals. The aim of the present study was to develop a greater understanding of DCD perceptions among staff involved.

Predictive energy equations are inaccurate for determining energy expenditure in adult burn injury: a retrospective observational study.

Background: Severe burn injuries are associated with hypermetabolism. This study aimed to compare the measured energy expenditure (mEE) with predicted energy requirements (pERs), and to correlate energy expenditure (EE) with clinical parameters in adults with severe burn injury.

Methods: Data were retrospectively analysed on 29 burn patients (median (interquartile range) age: 46 (28-61) years, % total body surface area burn: 37% (18-46%)) admitted to an intensive care unit.

Predictors of mortality after extracorporeal cardiopulmonary resuscitation.

Objective: Extracorporeal membrane oxygenation (ECMO) is a promising adjunct to cardiopulmonary resuscitation (CPR) in refractory cardiac arrest (CA). Factors associated with outcome are incompletely characterised. The aim of our study was to identify pre-ECMO factors associated with in-hospital mortality after extracorporeal CPR (ECPR).

Idiopathic systemic capillary leak syndrome presenting as septic shock: A case report.

Background: Idiopathic capillary leak syndrome (Clarkson's Disease) is a rare angiopathy with a heterogenous phenotype that may present as distributive shock refractory to resuscitative management.

Objective: We report a case of idiopathic systemic capillary leak syndrome presenting as septic shock.

Methods: Structured case report and review of the literature.

Cannulation technique: femoro-femoral.

The cannulation technique used during veno-venous extracorporeal membrane oxygenation (VV ECMO) insertion can have a major impact on a patients' overall outcome. We have developed a technique that aims to combine speed and effectiveness, with minimal risk. The steps include: (I) percutaneous cannulation using the Seldinger technique; (II) ultrasound guided access and positioning of cannulas; (III) femoro-femoral circuit configuration with a later option of high flow; (IV) a no skin cut serial dilation technique; (V) non-suturing securing of cannulas and (VI) a non-surgical manual pressure technique of explantation.

Hyperoxia in the intensive care unit and outcome after out-of-hospital ventricular fibrillation cardiac arrest.

Background: Laboratory and clinical studies have suggested that hyperoxia early after resuscitation from cardiac arrest may increase neurological injury and worsen outcome. Previous clinical studies have been small or have not included relevant prehospital data. We aimed to determine in a larger cohort of patients whether hyperoxia in the intensive care unit in patients admitted after out-of-hospital cardiac arrest (OHCA) was associated with increased mortality rate after correction for prehospital variables.