The cuff-leak test: what are we measuring?

Stridor is one of the most frequent causes of early extubation failure. The cuff-leak test may help to identify patients at risk to develop post-extubation laryngeal edema. However the discrimination power of the cuff-leak test is highly variable and can be use, at best, to detect patients at risk to develop edema but should not be used to postpone extubation as tracheal extubation can still be successful in many patients with a positive test. In this editorial, the author discuss the factors influencing the leak and hence its predictive value.     

Importance of neonatal strain imaging: what are we measuring?

The International Journal of Cardiovascular Imaging -     

CIS: where are we going and what should we demand from industry?

Clinical information systems designed for use in the critical care setting have been available for many years. Yet, despite significant evidence that these systems contribute to patient safety and efficiency of care, they have not achieved widespread use. This paper examines some of the factors responsible for the slow growth in use of clinical information systems in the intensive care unit. We further examine the elements that will be necessary to support widespread adoption of future clinical information systems. We give an outline of functionalities, processes, and standards that users will demand from industry as they develop the information systems of the future.     

Quality improvement framework for major amputation: are we getting it right?

Introduction: The quality improvement framework for major amputation was developed with the aim of improving outcomes and reducing the perioperartive mortality to less than 5% by 2015. The aim of the study was to assess our compliance with the framework guidelines and look for the reasons for non‐compliance. Method: All major amputations performed between 2008 and 2010 were included. The following data were collected: presence of infection ± tissue loss, status of arterial supply, revascularisation attempts, time to surgery, type of amputation, morbidity and mortality. Results: A total of 81 patients were included (42 BKAs, 39 AKAs). Ninety percentage had formal preoperative arterial investigations and 84% had an attempted revascularisation procedure. Patients who were transferred late from non‐vascular units (n = 12) had a 30‐day mortality of 50% whereas patients who presented directly to our unit had a 30‐day mortality of 7.2%. The number of amputations has decreased over the last 3 years from 34 to 21 per year, coinciding with the doubling of crural revascularisation procedures performed (from 60 to 120 per year). Ten patients underwent a revision from BKA to AKA because of an inadequate profunda femoris artery (PFA), whereas all those with a healed BKA stump either had a good PFA or a named crural vessel. Conclusion: The overall number of amputations is decreasing from year to year. By doubling our crural revascularisation procedures we are saving more limbs. Thirty‐day mortality is higher than expected, particularly in patients who present late. Expeditious referral may potentially improve the mortality rate among this group of patients.