We found insufficient evidence about the effects of BIS monitoring for sedation in critically ill mechanically ventilated adults on clinical outcomes or resource utilization. The findings are uncertain due to the low- and very low-quality evidence derived from a limited number of studies.

Based on a 22% response rate, our survey suggests that the risks of RA most commonly disclosed to patients by ASRA members are benign while severe complications of RA are far less commonly disclosed. There is little agreement among ASRA members regarding their perceived incidence of complications following RA.

The role of the neurointensivist in outcome for patients who suffer severe traumatic brain injury is key. Targeted therapies are allowing early detection and manipulation of brain ischaemia leading to more individualized treatment.

We identified that there was no clear consensus and considerable variation in practice in the management of TBI patients in UK neurocritical care units. A protocol-based management has been shown to improve outcome in sepsis patients. Given the magnitude of the problem, we conclude that there is an urgent need for international consensus guidelines for management of TBI patients in critical care units.

Effective management of TBI should go beyond formulaic-based pursuit of physiological targets and requires a detailed understanding of the multisystem response of the body.

To minimise the force of laryngoscopy and movement of a potentially unstable cervical spine injury, consideration should be given to the early use of a bougie.

Maintaining physiological targets in several areas remains part of protocol led care in the acute phase of TBI management. As evidence accumulates however, the target values and therefore therapies may be set to change.

SummaryThere is a discrepancy between resuscitation teaching and witnessed clinical practice. Furthermore, deleterious outcomes are associated with hyperventilation. We therefore conducted a manikinbased study of a simulated cardiac arrest to evaluate the ability of three ventilating devices to provide guideline-consistent ventilation. Mean (SD) minute ventilation was reduced with the paediatric self-inflating bag (7.0 (3.2) l.min )1 ) compared with the Mapleson C system (9.8 (3.5) l.min )1 ) and adult self-inflating bag (9.7 (4.2) l.min; p = 0.003). Tidal volume was also lower with the paediatric self-inflating bag (391 (52) ml) compared with the others (582 (87) ml and 625 (103) ml, respectively; p < 0.001), as was peak airway pressure (14.5 (5.2) cmH 2 O vs 20.7 (9.0) cmH 2 O and 30.3 (11.4) cmH 2