Approaching families for organ donation-intensivists' perspectives.

In Australia the initial approach to families for organ donation is almost always undertaken by intensivists. There is, however, a paucity of literature on intensivists' views on this approach and how their approach compares with recommendations in published literature on this subject. This study consisted of a survey of the views of intensive care consultants and senior intensive care registrars in the four major teaching hospitals in Perth, Western Australia, on how they approached families for organ donation. The study also includes a review of recently published literature on approaching families for organ donation. The survey results indicate that most intensive care consultants felt adequately trained to approach families for organ donation, but almost half of the group surveyed would prefer a collaborative approach with either a donor co-ordinator or a colleague with additional training on this subject. Despite recommendations in the literature and from the Australian and New Zealand Intensive Care Society to determine the registration status of potential donors on the Australian Organ Donation Registry prior to discussions with families, this was not always undertaken. In addition, the benefits of organ donation were not always discussed with families, nor were the reasons for refusal of consent sensitively explored.

Airway management in craniofacial surgery: experience in 542 patients.

Five hundred and forty-two patients undergoing 579 craniofacial surgical procedures were admitted to the Intensive Care Unit of the Hospital for Sick Children, Toronto, during the 13-year period of 1972 to 1984. Ninety-eight of these patients underwent tracheotomies; 12 significant complications were documented. Two hundred and seventy-eight patients were managed with nasal endotracheal intubation for greater than 24 hours postoperatively; 42 related complications were documented. Good communication among the craniofacial surgeon, otolaryngologist, anesthetist and intensivist is crucial for the safe management of the various airway problems observed in patients with major craniofacial anomalies undergoing corrective surgery.

When to extubate the croup patient: the "leak" test.

The reliability of "leak" as a criterion for elective extubation of children with croup treated with nasotracheal intubation was studied during the three month "croup epidemic" in Ontario of September 1, 1983 to November 30, 1983. Twenty-eight patients experienced 36 extubations; 31 planned and five accidental. Three of 23 (13 per cent) planned extubations with "leak" required reintubation whereas three of eight (38 per cent) children electively extubated after seven days of intubation without "leak" required reintubation. "Leak" is a helpful but not absolute prognostic indicator of a successful extubation.

A paediatric emergency transport service: one year's experience.

A paediatric emergency transport service (PETS) has been developed in Melbourne to cater for the secondary evacuation of children beyond the neonatal period. A consultative and transport service is provided. Forty-six children were transported in the first year of operation and the details are now reported. It is believed that the service is fulfilling a hiatus in the delivery of emergency health care to regional centres and that it will reduce morbidity and mortality in this group of critically ill children.

The period of nasotracheal intubation in acute epiglottitis.

Experience during the last three years with nasotracheal intubation in children with acute epiglottitis indicates that a period of intubation of 8-12 hours after the institution of appropriate antibiotic therapy is satisfactory in most patients. Shortening the period of intubation should have benefits to the patient. A shorter period of intubation should provide less opportunity for complications to develop and allow earlier discharge.