Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2001
Review Case ReportsSevere falciparum malaria in five soldiers from East Timor: a case series and literature review.
Despite chemoprophylaxis, malaria remains a serious threat for large numbers of non-immune soldiers deployed in endemic areas. Five adult cases of severe falciparum malaria are reported. Three cases were complicated by multiorgan failure and one of these patients died from cerebral malaria. ⋯ Understanding and management of malaria continues to evolve rapidly. The pathophysiology of acute lung injury, shock and brain injury associated with malaria are examined in light of recent research. This article discusses the current controversies of exchange blood transfusion and the use of the new artemisinin derivatives.
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Anaesth Intensive Care · Aug 2001
Intrahospital transport of critically ill patients: complications and difficulties.
An audit of 97 intrahospital transports of critically ill patients was undertaken within Westmead Hospital. The aims of this audit were to assess all factors that may lead to problems during intrahospital transports. At the completion of a transport medical staff were asked to provide information about their patient and their treatment, as well as any difficulties they may have encountered. ⋯ Of these, 31% were patient-related and 45% were related to equipment or the transport environment. (15% encountered problems in both areas). Many of the difficulties were preventable with adequate pre-transport communication and planning. Other problems were directly related to the increased severity of illness in these patients.
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Anaesth Intensive Care · Aug 2001
Relationship between work of breathing provided by a ventilator and patients' inspiratory drive during pressure support ventilation; effects of inspiratory rise time.
Inspiratory drive and work of breathing provided by a ventilator (WOBv) during pressure support ventilation (PSV) were examined in 15 patients. At PSV 10 and 15 cm H2O during CPAP 5 cm H2O, patients with low P0.1 (<4.2 cm H2O, n=9) showed WOBv 0.57 and 0.92 J/l, those with high P0.1 (>4.2 cm H2O, n=6) showed 0.31 and 0.62 J/l respectively. WOBv was smaller and pressure-time product of oesophageal pressure (PTP) was significantly larger in high P0.1 patients. ⋯ Compared with higher PSV, shorter IRT reduced PTP more. In conclusion, WOBv decreased as inspiratory drive increased due to inability to increase inspiratory flow. Increasing initial inspiratory flow was more effective than raising PSV to preserve inspiratory assistance of PSV at high inspiratory drive.