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This issue of Critical Care and Resuscitation  tackles a variety of key topics in intensive care medicine. First, it presents the issue of prophylaxis against venous thromboembolism (VTE) in patients with severe traumatic brain injury (TBI). Park and colleagues ¹  found that, in a cohort of 100 patients with severe TBI, early VTE chemoprophylaxis (first week) was uncommon. This was despite the almost complete lack of radiological evidence of intracranial haemorrhage after day 3 and relatively frequent pulmonary embolism after day 6. These findings, as discussed in the accompanying editorial, ²  are consistent with previous data from Australia and New Zealand from the Erythropoietin in TBI (EPO-TBI) randomised controlled trial. ³  EPO-TBI showed that Australian and New Zealand doctors applied chemoprophylaxis significantly more conservatively than their colleagues in other parts of the world. Such conservative approach was associated with a doubling in the risk of developing VTE. The reason for this uniquely conservative approach in Australia and New Zealand remains unclear, and this work suggests the need for the intensive care community to focus on improving the quality and timing of VTE prophylaxis in these complex patients.

Another area of relevance is related to the care of patients with large surface burns. In their point of view article, Holley and colleagues ⁴ call for the creation of a dedicated data collection and registry for such patients. This would be an important development, mirroring the growing interest in a similar approach in patients with acute liver failure. ⁵

In keeping with our commitment to publish protocols and statistical analysis plans for major trials involving Australian intensive care units (ICUs), ^{6, 7, 8, 9}  Nichol and colleagues ¹⁰ present the protocol for the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME). ¹⁰ TAME is a large trial, which, with 1700 randomised patients, is similar in magnitude to the recent Targeted Therapeutic Management-2 (TTM-2) trial (https://ttm2trial.org/). The recruitment for TAME has now been completed, and the 180-day follow-up is currently in progress.

Arunachala Murthy et al ¹¹  report the findings of an observational study of current practice in relation to protein delivery in ventilated patients. They found that current practice is to deliver 0.85 g/kg ideal body weight (IBW) per day, a value that is quite different from the estimated requirement of 1.46 g/kg IBW per day. Moreover, the recommended protein delivery of more than 1.2 g/kg IBW per day was only achieved on 29% of all study days. This study highlights the dissociation between practice and guidelines in this field and provides the necessary background in preparation for a future large trial of usual care versus guideline-based protein administration.

Another field that remains in need of attention and possibly improved practice is that of pressure support ventilation (PSV). Al-Bassam and colleagues ¹² report on a unique cohort of patients receiving prolonged ventilation in order to understand the prevalence and management of PSV in such patients. The findings are striking and confirm previous observations in Australia and New Zealand that PSV is a common form of therapy and yet it is prescribed in an adjusted and stereotypical way.

Durie and colleagues ¹³  report on the value of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) Coronavirus Clinical Characterisation Consortium (4C) Mortality Score to estimate the risk of death in patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand. They found that the ISARIC-4C Mortality Score performs poorly in our ICU environment and overestimates the risk of death. This information is important as it can help guide prognostication in the management of COVID-19 in Australian ICUs.

Other brief communications complete this issue of CCR  by focusing on specific problems, such as the impact of ethnicity on the outcome of cardiac arrest, ¹⁴  the demonstration that routine coagulation tests are likely unnecessary, ¹⁵ the findings that the measurement of weight in infants has a similar percentage of inaccuracy as in adults, ¹⁶ and the estimation of how many in-hospital cardiac arrests may occur in Australian hospitals every year. ¹⁷  All provide important epidemiologic information and quality improvement ideas to enhance patient care in Australian and New Zealand ICUs.