No abstract

The diagnosis and management of broncho-abdominal fistula in critically patients is difficult, with various treatment options including medical, surgical, ventilatory strategies and drainage systems. We report the case of a 58-year-old male patient who presented acutely with systemic sepsis 41 days after undergoing an elective laparoscopic cholecystectomy. The patient underwent a 34-day course of intensive care treatment during which the diagnosis of a broncho-abdominal fistula was made using a simple technique previously undescribed in the critical care literature. The case was subsequently managed successfully following the introduction of high frequency oscillatory ventilation (HFOV) as the principal mode of respiratory support. We describe the unusual presentation, the method of diagnosis and the subsequent management of this case using HFOV.

Transferring critically ill patients, whether intra- or inter-hospital, is an integral part of the daily working life of intensive care unit staff. It requires a multitude of skills, including thorough patient assessment, rigorous pre-transfer preparation, and constant vigilance throughout the transfer to ensure the safety of the patient. The development of these skills is a fundamental necessity for trainees in critical care. We investigated current critical care trainees' experience of patient transfer in one region in the UK, and assessed their views of their training in patient transfer. The results of our survey demonstrate some worrying conclusions about deficiencies in specific transfer training. We hope to encourage a discussion about the standards in transfer training which are needed and the best way to deliver such training.

No abstract

We undertook a web-based survey of intensive care units (ICUs) in England, Wales and Northern Ireland in order to deter-mine which groups of healthcare professionals were routinely being used to assist with stabilisation of critically ill patients outside the ICU. We also investigated what support was immediately available to patients with acute airway problems on the units themselves. We found that assistants often lack the training required to safely assist the ICU doctor. Out of hours, almost 38% of hospitals use under-skilled assistants during emergency intubations. Over 50% of units rely on theatre anaesthetists or non-resident consultants for emergency airway support if the ICU doctor is not available. To ensure patient safety, formal guidelines should be introduced at national and local levels to identify who should be assisting with stabilisation of critically ill patients and what level of training they should receive. This should be subject to regular audit.