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The incidence of organ donation after circulatory death (DCD) in Australia and New Zealand (ANZ) has steadily increased in recent years. Intensive care doctors are vital to the implementation of DCD and healthcare professionals' attitudes to DCD can influence their participation. In order to determine ANZ intensive care doctors' attitudes to DCD, to explore if demographic characteristics influence attitude to DCD and to assess if attitude to DCD can predict palliative prescription rationale at the end of life of DCD donors, a cross-sectional online survey was distributed to ANZ intensive care doctors and responses collected between 29 April and 10 June 2016. Exploratory factor analysis was used to define various attributes of attitude to DCD. Results were subjected to comparative statistical analyses to examine the relation between demographic data and attitude to DCD. Multiple regression models were used to examine if attitude to DCD could predict intensive care doctors' palliative prescription rationales at the end of life of DCD donors. One hundred and sixty-one intensive care doctors responded to the survey with 69.4% having worked in intensive care for ten years or more. Respondents responded positively to the support of and perceived importance of DCD in helping those who would benefit from the donations (constructive attributes)(mean composite factor score = 3.84, standard deviation [SD] 0.83), they positively perceived that conducive and facilitative orchestration of DCD helps families cope (mean composite factor score = 3.94, SD 0.72) and that they would manage a DCD donor similar to any patient at the end of their life (mean score = 3.94, SD 0.72). Respondents responded negatively to having concerns that the circulatory death of potential DCD donors does not occur within the specified time frame (mean score = 2.28, SD 1.02). There was an association between organ donation professional education courses, familiarity with national guidelines and positive attitudes to certain attributes of attitude to DCD. Regression models demonstrated the attitude to DCD may predict intensive care doctors' palliative medication prescription rationales at the end of life of the DCD donor. Intensive care doctors in ANZ adopt a morally neutral attitude to DCD where they recognise the importance of organ donation, and support and conduct DCD as a part of good end-of-life care. [ABSTRACT FROM AUTHOR]

Nicotine replacement therapy (NRT) is a common first-line treatment to prevent nicotine withdrawal in smokers. However, available literature reports conflicting results regarding its efficacy and safety in critically ill patients. The objective of this study was to evaluate the relationship between NRT in smokers in the intensive care unit (ICU) and outcomes. This case-control study was conducted in a university-affiliated tertiary hospital ICU. Over a period of five years, 126 active smokers who received transdermal NRT were matched to 126 active smokers who did not receive NRT. The groups were case-matched for sex, age and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The primary outcome was administration of antipsychotic medication. Secondary outcomes included use of physical restraints, 30-day mortality, and ventilation requirements. Antipsychotic medication was prescribed in 43 (34.1%) patients who received NRT compared to 14 (11.1%) in controls (P <0.01). Physical restraints were used in 37 (29.4%) patients who received NRT, compared to 12 (9.5%) of controls (P <0.01). The 30-day mortality and number of patients intubated was not statistically different between groups. Average length of intubation time was greater in the NRT group (2.56 days; standard deviation 4.16) compared to the control group (1.44 days; standard deviation 2.68) (P=0.012). The use of NRT to prevent nicotine withdrawal in ICU patients is associated with increased use of antipsychotic medication and physical restraint, and with prolonged mechanical ventilation. [ABSTRACT FROM AUTHOR]

Septic shock is characterised by vasodilation, myocardial depression and impaired microcirculatory blood flow, resulting in redistribution of regional blood flow. Animal and human studies have shown that gastrointestinal mucosal blood flow is impaired in septic shock. This is consistent with abnormalities found in many other microcirculatory vascular beds. Gastrointestinal mucosal microcirculatory perfusion deficits have been associated with gut injury and a decrease in gut barrier function, possibly causing augmentation of systemic inflammation and distant organ dysfunction. A range of techniques have been developed and used to quantify these gastrointestinal perfusion abnormalities. The following techniques have been used to study gastrointestinal perfusion in humans: tonometry, laser Doppler flowmetry, reflectance spectrophotometry, near-infrared spectroscopy, orthogonal polarisation spectral imaging, indocyanine green clearance, hepatic vein catheterisation and measurements of plasma D-lactate. Although these methods share the ability to predict outcome in septic shock patients, it is important to emphasise that the measurement results are not interchangeable. Different techniques measure different elements of gastrointestinal perfusion. Gastric tonometry is currently the most widely used technique because of its non-invasiveness and ease of use. Despite all the recent advances, the usefulness of gastrointestinal perfusion parameters in clinical decision-making is still limited. Treatment strategies specifically aimed at improving gastrointestinal perfuision have failed to actually correct mucosal perfusion abnormalities and hence not shown to improve important clinical endpoints. Current and future treatment strategies for septic shock should be tested for their effects on gastrointestinal perfusion; to further clarify its exact role in patient management, and to prevent therapies detrimental to gastrointestinal perfusion being implemented. [ABSTRACT FROM AUTHOR]

Low-molecular-weight heparins are routinely used to prevent deep venous thrombosis following renal transplantation in our department. We report 2 patients who developed tender erythematous subcutaneous nodules with induration, ulceration and necrosis at the site of subcutaneous administration of nadroparin. Both patients were renal transplant recipients with impaired graft function and high serum calcium-phosphate products. The diagnosis calcinosis cutis was confirmed by technetium-99m bone scan and by histological examination of biopsies. Both patients showed spontaneous recovery several weeks after discontinuation of nadroparin. Patients with chronic renal failure and hyperphosphatemia may be predisposed to develop calcinosis cutis. In addition, the role of the calcium content of nadroparin is discussed.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]