Air sampling directly onto a methicillin-resistant Staphylococcus aureus (MRSA) selective agar was performed at six locations three times weekly over a period of 32 weeks in a new, initially MRSA-free Intensive Care Unit to examine if MRSA is present in air sample cultures and, if so, whether it is affected by the number of MRSA colonized patients present. A total of 480 air samples were collected on 80 days. A total of 39/480 (8.1%) samples were found to be MRSA positive of which 24/160 (15%) positive air samples were from the single rooms, where MRSA colonised patients were isolated, and 15/320 (4.7%) were from the open bed areas. A significant correlation was found between the daily number of MRSA colonized or infected patients in the Unit and the daily number of MRSA positive air samples cultures obtained (r 2 =0.128; P<0.005). The frequency of positive cultures was significantly higher in the single rooms than in the open bed areas (relative risk=3.2; P<0.001). The results from one of the single rooms showed a strong correlation between the presence of MRSA patients and MRSA positive air samples (relative risk=11.4; P<0.005). Our findings demonstrate that the presence of airborne MRSA in our unit is strongly related to the presence and number of MRSA colonized or infected patients in the Unit.

A 23-year-old primigravida with Lemierre's syndrome developed pericardial tamponade secondary to mediastinal infection and anticoagulant therapy. Intrathoracic echocardiographic diagnosis during a period of cardiac arrest led to urgent pericardiocentesis and successful resuscitation.

The role of transoesophageal echocardiography (TOE) in a general intensive care unit was examined by reviewing all studies performed in a major metropolitan hospital over a two-year period. TOE was performed on 53 patients where transthoracic studies were inadequate, the indications being cardiac source of embolus (13/53), thoracic aorta abnormalities (5/53), left ventricular systolic function (22/53), endocarditis (6/53), right heart pathology (2/53), pulmonary embolus (2/53), or a potentially surgical correctable lesion (3/53). Findings were categorized into three groups: confirming suspected pathology (18/53), major incidental findings (6/53), or normal (29/53). Patient management was altered, not only by the finding of positive pathology, but also after identifying normal left ventricular systolic function (14/53). Echocardiography has become an invaluable tool in the ICU setting.

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