The human gut microbiome is truly mind-boggling. We are teaming with microorganisms and their presence has been implicated not just in C. difficile colitis but in obesity, cardiovascular disease and a whole host of other diseases. The suggestion has even been made that our genetic code should be described as not only the DNA found within our cells, but as an amalgamation of that and the genes found in the microorganisms that surround and cover us – that the microorganisms are an intrinsic part of ‘us’.
Healthcare is a high risk and complex environment, and discussion of risk is emotive (take, for example, the headline chosen by the Times to put above a story making some effort to explain a fair blame approach).
In trying to make sense of this this complex difficult and uncomfortable area however, one of the first steps must be to quantify and describe the risk.
Unplanned admissions to critical care would seem a reasonable place to look; sampling such cases for review is an accepted method that in an ideal world all critical care units would do in co-operation with the rest of the hospital.
As far as complications go, anastomotic leak after emergency bowel surgery is not to be recommended. The early identification of a leak is crucial. C-Reactive Protein (CRP) has been suggested as a marker that may be useful to identifying this complication, but the question is whether it is useful in the case of the high risk emergency laparotomy in the critical care environment.
I picked up this paper as a local news story rather than because of its content - it was written by our local neurosurgical research group. Turns out it was very interesting, but not for the reasons I thought it might be..
One of our simulation scenarios involves treating a head injured patient. Just before we leave to get into the ambulance, the pupils become fixed and dilated. We then discuss whether to transfer the patient or not, with all groups to date feeling that yes, we should. But what is the prognosis for patients with bilateral fixed dilated pupils (BFDPs) after an acute extradural or subdural haemorrhage?
Does the use of cardiac output monitoring make a difference? NICE seem to think so, the Cochrane group are less certain. What we needed was a large, well conducted trial and this is what we got...
So long as you don’t overfeed, providing enteral nutrition is a good thing to do. It provides nutrients, and maintains gut integrity.* (For a review of why the latter is hugely important in critical care click here)
This is a collection of blog posts written about new research or topics of interest.
This site is written for healthcare professionals. Nothing on it constitutes medical advice, and opinions expressed are those of the authors.
Dr Peter Hersey & Dr Laura O'Connor