SummaryThe aim of the study was to assess the effectiveness of computed tomography in the management of critically ill patients. We performed a prospective study over a 4-month period. The requesting clinician was asked to document their clinical diagnosis and confidence thereof on a visual analogue scale. They were also asked about their management plan if computed tomography had not been available. After imaging, any change in the management plan was assessed. During the study period, 16 computed tomograms were performed on 14 patients. There were 21 possible clinical diagnoses: of these eight were confirmed, and 13 were refuted. Seven new diagnoses were established. Computed tomography did not help in the management of two patients and it led to more confusion in the management of one patient. The management of seven patients was altered after computed tomography and in six the management depended solely on computed tomography findings.

There are many risks to skin integrity at the perioperative period, and these risks may exert their effect well into the ICU admission period. It is imperative to identify and mitigate these factors in order to reduce PU incidence, morbidity and mortality.

A 48-year-old man with severe Guillain-Barré syndrome suffered complete paralysis, and for 31 days could not communicate with the outside world, while remaining fully conscious. After recovery, he provided feedback on aspects of his care, such as mechanical ventilation, physical therapy, and communication. Conventional low tidal volume normocapnic ventilation induced ongoing and profound dyspnoea, occasionally relieved by modest increases in minute ventilation. Routine and apparently benign physical therapy was extremely painful, which was not reflected in heart rate or blood pressure changes. When he eventually re-established communication after many weeks, via slight eye movements, his first message was to express a particular distressing symptom. His case is a valuable reminder of the sometimes large gap between clinical measurements and assumptions and the subjective patient experience. We propose several approaches to address such issues in other paralysed but conscious patients.