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Objective Patients in the intensive care unit (ICU) have increased risk of pressure injury (PI) development due to critical illness. This study compared two silicone dressings used in the Australian ICU setting for sacral PI prevention. Design A cluster-controlled clinical trial of two sacral dressings with four alternating periods of three months' duration. Setting A 10-bed general adult ICU in outer-metropolitan Brisbane, Queensland, Australia. Participants Adult participants who did not have a sacral PI present on ICU admission and were able to have a dressing applied for more than 24 hours without repeated dislodgement or soiling in a 24-hour period (>3 times). Interventions Dressing 1 (Allevyn Gentle Border Sacrum™, Smith & Nephew) and Dressing 2 (Mepilex Border Sacrum™, Mölnlycke). Main outcomes measures The primary outcome was the incidence of a new sacral PI (stage 1 or greater) per 100 dressing days in the ICU. Secondary outcomes were the mean number of dressings per patient, the cost difference of dressings to prevent a sacral PI and product integrity. Results There was no difference in the incidence of a new sacral PI (0.44 per 100 dressing days for both products, p = 1.00), the mean number of dressings per patient per day (0.50 for both products, p = 0.51) and product integrity (85% for Dressing 1 and 84% for Dressing 2, p = 0.69). There was a dressing cost difference per patient (A$10.29 for Dressing 1 and A$28.84 for Dressing 2, p < 0.001). Conclusions Similar efficacy, product use and product integrity, but differential cost, were observed for two prophylactic silicone dressings in the prevention of PIs in the intensive care patient. We recommend the use of sacral prophylactic dressings for at-risk patients, with the choice of product based on ease of application, clinician preference and overall cost-effectiveness of the dressing. [ABSTRACT FROM AUTHOR]

Data on the occurrence and outcome of patients with chronic obstructive pulmonary disease (COPD) and ventilator-associated pneumonia (VAP) are quite limited. The aim of this study was to determine if COPD intensive care unit (ICU) patients have a higher rate of VAP development, different microbiological aetiology or have worse outcomes than other patients without VAP. A secondary analysis of a large prospective, observational study conducted in 27 European ICUs was carried out. Trauma patients were excluded. Of 2082 intubated patients included in the study, 397 (19.1 %) had COPD; 79 (19.9 %) patients with COPD and 332 (19.7 %) patients without COPD developed VAP. ICU mortality increased by 17 % ( p < 0.05) when COPD patients developed VAP, remaining an independent predictor of mortality [odds ratio (OR) 2.28; 95 % confidence interval (CI) 1.35-3.87]. The development of VAP in COPD patients was associated with a median increase of 12 days in the duration of mechanical ventilation and >13 days in ICU stay ( p < 0.05). Pseudomonas aeruginosa was more common in VAP when COPD was present (29.1 % vs. 18.7 %, p = 0.04) and was the most frequent isolate in COPD patients with early-onset VAP, with a frequency 2.5 times higher than in patients without early-onset VAP (33.3 % vs. 13.3 %, p = 0.03). COPD patients are not more predisposed to VAP than other ICU patients, but if COPD patients develop VAP, they have a worse outcome. Antibiotic coverage for non-fermenters needs to be included in the empiric therapy of all COPD patients, even in early-onset VAP. [ABSTRACT FROM AUTHOR]

Objective: To develop a theoretical and clinical model based on tangential (follower) loading as a method of optimal force transmission in the spine to explain the traditional chiropractic concept of a vertebral subluxation and as a description and rational for the clinical entity that has been the object of chiropractic manipulative therapy (adjustment). Method: A brief review of the literature and relevant texts relating to the application of the mechanical concept of follower and tangential loads to the spine and the chiropractic concept of the vertebral subluxation was undertaken to determine common factors and inter-related components. Results: Relevant information from the literature relating to follower and tangential loading of the spine, vertebral subluxations and manipulation was correlated and synthesised into a model describing normal spinal mechanics and the loss of mechanical integrity of the spine. The model was developed as a theoretical basis for the chiropractic concept of the vertebral subluxation and as a mechanical rationale for spinal manipulation. Three key components were identified that were common to follower and tangential loads, subluxations and manipulation of the spine and were incorporated into the model. These involved active components, passive elements and feedback mechanisms previously described by Panjabi. Conclusion: The mechanical concepts underlying tangential loading of the spine have been applied to the chiropractic concept of the vertebral subluxation and spinal adjustment. Load theory and research provides chiropractic with a testable hypothesis for the clinical response to the adjustment and a theoretical basis for the subluxation as a clinical entity. [ABSTRACT FROM AUTHOR]

The article focuses on a study which explored the incidence, risk factors and mortality associated with Enterococcus positive isolate in patients admitted to tertiary intensive care units (ICU). The study included patients at the ICU of Royal Brisbane and Women's Hospital, and Westmead Hospital. It found that positive enterococcal isolate can be used as a marker of underlying severity of illness. Study authors concluded that the efficacy of enterococci-directed empiric therapy is still not proven.

This study reports the incidence and associated mortality of acquired hypernatraemia (Na > 150 mmol.l−1) in a general medical/surgical intensive care unit. Patients admitted over a 5-year period with normal sodium values were eligible for inclusion; exclusions were made for burn/neurosurgical diagnoses and for hypertonic saline therapy. From 3475 admissions (3317 patients), 266 (7.7%) episodes of hypernatraemia were observed. Hospital mortality was 33.5% in the hypernatraemic group and 7.7% in the normonatraemic group (p < 0.001). Acquired hypernatraemia was an independent risk factor for in-hospital mortality (OR 1.97, 95% CI 1.37–2.82, p < 0.001). Intermediate sodium levels (145–150 mmol.l−1) were associated with increased mortality (OR 1.42, 95% CI 1.02–1.98). Uncorrected sodium at discharge (p = 0.001) and peak sodium (p = 0.001) were better predictors of mortality than time to onset (p = 0.71) and duration of hypernatraemia (p = 1.0). Hypernatraemia avoidance is justified, but determinants of hypernatraemia and benefits of targeted treatment strategies require further elucidation. [ABSTRACT FROM AUTHOR]