IN THIS ISSUE OF CCR
This issue of Critical Care and Resuscitation focuses on several key aspects of modern intensive care unit (ICU) practice in Australia and New Zealand. Organ donation is particularly prominent, with two original articles and a dedicated editorial. 1, 2, 3The first article provides strong evidence that, in more difficult organ donation family conversations (ie, when there is no evidence of organ donation registry presence and organ donation is not raised by the family), the likelihood of successful donation is significantly increased by such conversation being led by an organ donation specialist. As supported by the editorial, it is increasingly clear that in this field, like all other aspects of critical care practice, training and specialisation make a difference. The second article demonstrates that organ donation can be successfully achieved under time pressure, even for highly vasopressor-dependent donors, and with good long term outcome when applying an expedited organ donation process. The implications are clear.
This issue of Critical Care and Resuscitation focuses on several key aspects of modern intensive care unit (ICU) practice in Australia and New Zealand. Organ donation is particularly prominent, with two original articles and a dedicated editorial. 1, 2, 3
Radford S, D’Costa R, Opdam H, et al. The impact of organ donation specialists on consent rate in challenging organ donation conversations. Crit Care Resusc 2020; 22: 297-302.
D’Costa RL, Radford S, Opdam HI, et al. Expedited organ donation in Victoria, Australia: donor characteristics and donation outcomes. Crit Care Resusc 2020; 22: 303-311.
French C. Communication works for those who work at it. Crit Care Resusc 2020; 22: 295-296.
Coronavirus infectious disease 2019 (COVID-19) continues to loom large, with a report on the outcomes of COVID-19 critical illness in Sweden, 4correspondence on the use of angiotensin II in ward patients, 5and consideration of whether patients with COVID-19 should all be managed in high volume ICUs. 6
Mårtensson J, Engerström L, Walther S, et al. COVID-19 critical illness in Sweden: characteristics and outcomes at a national population level. Crit Care Resusc 2020; 22: 312-320.
Morselli F, Vitali G, Brioschi E, et al. Feasibility and safety of angiotensin II administration in general ward patients during COVID-19 pandemic: a case series. Crit Care Resusc 2020; 22: 388-390.
Ramanan M, Burrell A, Udy A; SPRINT-SARI Australia Investigators. Should critically ill patients with COVID-19 be managed in high-volume ICUs? Crit Care Resusc 2020; 22: 394-396.
A randomised controlled trial reports attempts to decrease nausea and vomiting in postoperative patients admitted to the ICU by using chewing gum prophylaxis, 7an intervention recently shown effective in the immediate postoperative period. 8The results are of interest to all intensivists involved in postoperative care.
Abdelkarim H, Ciampoli N, Zwakman-Hessels L, et al. Chewing gum prophylaxis for postoperative nausea and vomiting in the intensive care unit: a pilot randomised controlled trial. Crit Care Resusc 2020; 22: 321-326.
Darvall JN, Handscombe M, Leslie K. Chewing gum for the treatment of postoperative nausea and vomiting: a pilot randomized controlled trial. Br J Anaesth 2017; 118: 83-9.
Is it safe to deliver extracorporeal membrane oxygenation in a low volume centre? How do patients admitted to regional and rural Australian ICUs fare? These questions are addressed by two important observational studies in Australia. 9, 10The results support the widespread quality of intensive care management in our region.
Joyce CJ, Cook DA, Walsham J, et al. Low volume ECMO results study. Crit Care Resusc 2020; 22: 327-334.
Secombe P, Brown A, Bailey M, et al. Characteristics and outcomes of patients admitted to regional and rural intensive care units in Australia. Crit Care Resusc 2020; 22: 335-343
Two other observational studies tackle the issue of angiotensin-converting enzyme 2 and acute kidney injury prediction 11and of delirium assessment and management in Australian and New Zealand ICUs. 12They provide novel insights into biomarkers of acute kidney injury and suggest that delirium care remains imperfect.
Bitker L, Patel SK, Bittar I, et al. Reduced urinary levels of angiotensin-converting enzyme 2 activity predict acute kidney injury in critically ill patients. Crit Care Resusc 2020; 22: 344-354.
Ankravs MJ, Udy AA, Byrne K, et al; George Institute for Global Health and Australian and New Zealand Intensive Care Society Clinical Trials Group. A multicentre point prevalence study of delirium assessment and management in patients admitted to Australian and New Zealand intensive care units. Crit Care Resusc 2020; 22: 355-360.
Two studies focus on the ecology of ICU management. The first investigates the environment of the ICU with regard to temperature, relative humidity, and light and sound intensity, and describes how profoundly non-physiological the environment is at every level from the normal human circadian point of view, and identifies several aspects of care that can be improved to make ICU ecology more patient-centred. 13The second tackles the issue of waste in the form of unnecessary arterial blood gas assessment and demonstrates how, in a large ICU, the introduction of an education program and guidelines results in saving close to $800 000 and 100 litres of blood over a one-year period without any impact on mortality. 14
Boots R, Mead G, Rawashdeh O, et al; Circadian Investigators in Critical Illness. Circadian Hygiene in the ICU Environment (CHIE) study. Crit Care Resusc 2020; 22: 361-369.
Walsh OM, Davis K, Gatward J. Reducing inappropriate arterial blood gas testing in a level III intensive care unit: a before-and-after observational study. Crit Care Resusc 2020; 22: 370-377.
Finally, a detailed investigation focuses on persistent critical illness and reports on the complications associated with this condition in 1200 patients. 15It finds that, while the prevalence of complications is much higher than in other ICU patients, the rate is not, and that some specific complications are particularly prevalent in such patients. These observations open the door to directed interventions in patients at high risk of persistent critical illness.
Tseitkin B, Mårtensson J, Eastwood GM, et al. Nature and impact of in-hospital complications associated with persistent critical illness. Crit Care Resusc 2020; 22: 378-387.