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INTENSIVE CARE Powered By Docstoc
					intensiVe caRe


                                          Projects in progress or completed        The team

                                          – CHARLI 2 trial – a phase 2             Assoc Prof John D Santamaria,
                                            randomised, blinded trial of           Director, Department Head; Dr
                                            nebulised heparin in patients          Barry Dixon, Intensivist; Jenny
                                            requiring mechanical ventilation       Holmes, Research Coordinator; David
                                            for more than 48 hours.                Reid, Data Manager; Roger Smith,
                                          – Investigations into a TNF inhibitor    Research Coordinator; Dr Antony
                                            to limit complications following       Tobin, Intensivist
The Intensive Care Unit provides            complex surgery.
all advanced life-support                 – Microvascular thrombosis               Highlights
services for St. Vincent’s as well          following aprotinin administration     Dr Barry Dixon has continued his
as management of emergency                  in cardiac surgery.                    studies on lung inflammation
resuscitation on the campus and a         – The impact of heparin on the lung      with a histological review of lung
range of follow-up programs.                microcirculation in cardiac surgical   biopsies taken at the time of cardiac
                                            patients.                              surgery to assess the degree of
About us                                  – The impact of the intensive care       microvascular thrombosis. The
The Intensive Care Unit (ICU) treats        discharge process on patient           original observations of intravascular
between 1,000 and 1,200 patients            outcomes.                              thrombosis in lung injury have
annually, approximately 450 of                                                     led to therapeutic trials involving
                                          – The impact of medical emergency
whom undergo cardiac surgery.                                                      nebulised heparin and intravenous
                                            team on hospital mortality.
The unit is accredited for advanced                                                TNF inhibitor.
                                          – The impact of a team approach to
training of intensive care specialists.     care of patients with tracheostomy     In the area of outcomes of ICU, the
The ICU’s research program has              tubes study.                           impact of a tracheostomy review
concentrated on three areas during        – Normoglycaemia in Intensive Care       service was published and the longer
2008. The first relates to acute lung       (NICE) study.                          term benefits of a medical emergency
injury and the role of intravascular                                               team were presented and submitted
                                          – Randomised Evaluation of Normal
thrombosis. The second looks                                                       for publication. Following successful
                                            versus Augmented Level of renal
at outcomes of clinical practice                                                   application for funding, a large multi-
                                            replacement therapy (RENAL) study.
while the third is participation in                                                centre study on patients discharged
                                          – The Early Nasojejunal Tube to Meet
the Australian and New Zealand                                                     from ICU will be undertaken during
                                            Energy Requirements in Intensive
Intensive Care Society Clinical Trials                                             2009; it is anticipated that nearly
                                            Care (ENTERIC) study.
Group network.                                                                     10,000 patients will be recruited for
                                          – VTE prophylaxis point prevalence       this study.
                                            audit and VTE prophylaxis sepsis
                                          – Early parenteral nutrition study.
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     ICU has been an active member              Publications
     of the ANZICS Clinical Trial Group         Condon EM, Tobin A 2008, ‘Haemophilus
     (CTG), which has been responsible          influenzae associated Guillain Barre
     for several large studies in               Syndrome with thrombocytopenic purpura
                                                and hyperthermia’, Anaesth Intensive Care,
     Australasia. Two important studies         36, 5, 722-5
     were completed in 2008 – the
     Normoglycaemia in Intensive Care           Deane AM, Reid DA, Tobin AE 2008,
                                                ‘Predicted body weight during mechanical
     (NICE) and Randomised Evaluation of        ventilation: using arm demispan to aid
     Normal versus Augmented Level of           clinical assessment’, Crit Care Resusc, 10, 1, 14
     renal replacement therapy (RENAL).
                                                Dixon B, Santamaria JD, Campbell DJ 2008,
     Other studies involve the role of early    ‘A phase 1 trial of nebulised heparin in acute
     parenteral nutrition, the benefits of      lung injury’, Crit Care, 12, 3, R64
     nasojejunal feeding and importance
                                                Dixon B, Campbell DJ, Santamaria JD
     of head of bed elevation.                  2008, ‘Elevated pulmonary dead space
                                                and coagulation abnormalities suggest
                                                lung microvascular thrombosis in patients
                                                undergoing cardiac surgery’, Intensive Care
     Dixon B                                    Med

     The contribution of inflammation           Duke GJ, Santamaria J, Shann F, Stow P,
     and anti-fibrinolytic agents to lung       Pilcher D, Ernest D, George C 2008, ‘Critical
                                                care outcome prediction equation (COPE)
     injury in cardiac surgery. St. Vincent’s
                                                for adult intensive care’, Crit Care Resusc,
     Research Endowment Fund (2008-             10, 1, 41
     2009) $21,750
                                                Myburgh JA, Higgins A, Jovanovska A,
     Investigations into a TNF antagonist       Lipman J, Ramakrishnan N, Santamaria J
                                                2008, ‘A comparison of epinephrine and
     to limit complications following           norepinephrine in critically ill patients’,
     cardiac surgery. National Heart            Intensive Care Med, 34, 12, 2226-34
     Foundation, (2008-2010), $126,000
                                                Tobin AE, Santamaria JD 2008, ‘An
                                                intensivist-led tracheostomy review team is
                                                associated with shorter decannulation time
                                                and length of stay: a prospective cohort
                                                study’, Crit Care, 12, 2, R48