Using a multicentre adult patient database from Australia and New Zealand, we obtained the lowest and highest temperature in the first 24 h after admission to the intensive care unit after elective non-cardiac surgery. Hypothermia was defined as core temperature < 36°C; transient hypothermia as a temperature < 36°C that was corrected within 24 h, and persistent hypothermia as hypothermia not corrected within 24 h. We studied 50 689 patients. Unintentional hypothermia is common in the early postoperative period [1][2][3][4][5]. Current evidence, including small randomised trials, suggests that a decrease in tympanic temperature of 1-3°C is associated with physiological derangements and complications that may be reduced by active warming [6][7][8][9][10][11][12][13]. This evidence has led many anaesthetists to strive to maintain normothermia for patients in the peri-operative period. Despite this being common practice, there are only a few studies of the epidemiology of hypothermia [2][3][4][5] and those that exist are limited in scope and external validity by being single centre in nature.To our knowledge, no large epidemiological multicentre studies of postoperative hypothermia in the intensive care unit (ICU) have been conducted among patients after non-cardiac surgery. We considered the hypothesis that, in patients admitted to the ICU after all types of major elective non-cardiac surgery, hypothermia might be both common and independently associated with increased mortality, and that this Anaesthesia

A 28-year-old obese woman (body mass index [BMI], 57 kg/m 2 ) presented to the emergency department (ED) with a history of 5 days of sore throat, lethargy and myalgias, and a clear chest x-ray, followed by 2 days of dyspnoea, productive cough, and pleuritic chest pain. She was febrile (40°C), and had tachypnoea (respiratory rate, 36 breaths/min) and hypoxia (oxygen saturation measured by pulse oximetry [SpO 2 ], 87% on 15 L/min oxygen via face mask). Her admission chest x-ray showed widespread alveolar infiltrates. She had a normal white cell count (WCC) of 6.3 10 9 /L, but an elevated serum C-reactive protein (CRP) level of 221 mg/L (reference ranges shown in Box 1). She was admitted to the intensive care unit (ICU) and, after a brief trial of noninvasive ventilation (NIV), was intubated and treated with mechanical ventilation (MV) with a fraction of inspired oxygen (FiO 2 ) of 1.0 and positive end-expiratory pressure (PEEP) of 20 cm H 2 O for the first 24 hours to maintain an SpO 2 > 89%. She was treated with inotropes for septic shock and with renal replacement therapy for acute renal failure. Therapy with oseltamivir in addition to empiric broad-spectrum antibiotics was commenced. Bacterial cultures of blood, urine and tracheal aspirate were negative. The result of a test for urine pneumococcal antigen was negative. The patient was successfully weaned from ventilatory support on Day 14. Patient 2A previously well 24-year-old man (BMI, 22 kg/m 2 ) was admitted to a regional hospital with a 1-week history of dry cough, fever, headache, abdominal pain, and vomiting. Thirty-six hours later, he was transferred to a metropolitan hospital because of worsening dyspnoea and hypoxia (SpO 2 , 88% on 15 L/min oxygen via face mask). He had tachycardia (110 beats/min), tachypnoea (respiratory rate, 34 breaths/min) and was febrile (39.9°C). He had a normal WCC (4.2 10 9 /L) but an elevated CRP level (256 mg/L).A chest x-ray showed unilateral lobar consolidation. He was transferred to the ICU and treated with oseltamivir, broad-spectrum antibiotics, and NIV with an FiO 2 of 1.0. After 96 hours, his hypoxia remained severe (partial pressure of arterial oxygen [PaO 2 ] to FiO 2 ratio, < 100), another chest x-ray showed bilateral alveolar infiltrates, and he was intubated and MV was commenced with an FiO 2 of 1.0 and high-level PEEP (20 cm H 2 O) for several days.Bacterial cultures and urine pneumococcal antigen test results were negative. Oseltamivir therapy was continued for 7 days, and MV for 15 days. Patient 3A 26-year-old obese man (BMI, > 40 kg/m 2 ) with a history of mild asthma presented after 2 days of nausea without vomiting, and no fever or cough. On the day of admission, he developed shortness of breath. He was found to be hypoxic (SpO 2 , 90% on an FiO 2 of 1.0) with bilateral pulmonary infiltrates showing on a chest x-ray. His WCC was 5.6 10 9 /L and CRP level was 137 mg/L. Therapy with broad-spectrum antibiotics and oseltamivir was commenced. He was intubated, and MV was commenced with an FiO 2 of > 0.6 and high-...

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Commonly performed laboratory tests identify surgical ward patients at risk of early major adverse events. Further studies are needed to assess whether such identification system can be used to trigger interventions that help improve patient outcomes.

Docetaxel chemotherapy is increasingly used in the treatment of castration-resistant prostate cancer. Cutaneous toxicity is common with docetaxel, occurring in up to 75% of cases. We present an unusual case of castration-resistant prostate cancer in which our patient developed recurrent but transient episodes of skin rash following each cycle of docetaxel. Initially, the rash was attributed to docetaxel cutaneous toxicity however a microbiological diagnosis of Trichophyton rubrum was subsequently made. We postulated that dexamethasone pre-medication transiently suppressed anti-fungal immunity, and indeed further flares were prevented by significantly reducing the dose of dexamethasone while continuing treatment with docetaxel.