Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2002
Comparative StudySurvival following mechanical ventilation of recipients of bone marrow transplants and peripheral blood stem cell transplants.
Survival of bone marrow transplant recipients requiring mechanical ventilation is poor but improving. This study reports a retrospective audit of all haematopoietic stem cell transplant (HSCT) recipients requiring mechanical ventilation at an Australian institution over a period spanning 11 years from 1988 to 1998. ⋯ Risk factors for mortality in the HSCT recipient requiring mechanical ventilation include renal, hepatic and cardiovascular insufficiency and greater severity of illness. Mechanical ventilation of HSCT recipients should not be regarded as futile therapy.
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Anaesth Intensive Care · Jun 2002
Comparative StudyVariability in infusion pressure and continuous flow rate delivered from pressurized bag pump flush systems.
Using 10 different infusion bag pressure pumps, indicated manometer pressures were compared with measured infusion pressures proximal to the flow-regulating device in an in vitro experiment. Flow rates delivered through the flow-regulating device were gravimetrically measured at different monitored pressure levels. Significant differences were found between manometer and measured infusion pressures among the tested pressure bagpumps (e.g. 500 ml bag volumepressurized to 300 mmHg manometerpressure: 219.6 +/- 7.8 to 407.2 +/- 2.7 mmHg). ⋯ Flow rates delivered through the flow-regulating device were directly correlated to the measured infusion pressure (r2= 0.9926). Differences inflow rates can have a considerable impact on maintaining catheter patency and avoidance of fluid overload and retrograde flushing into the central arterial circulation in neonates and small children. A simple manoeuvre using the invasive pressure transducer allows monitoring and adjustment of the infusion pressure in the clinical setting.
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Anaesth Intensive Care · Jun 2002
Comparative StudyProcalcitonin and proinflammatory cytokine clearance during continuous venovenous haemofiltration in septic patients.
Procalcitonin (PCT), interleukin-6 (IL-6), tumour necrosis factor a (TNFalpha), and interleukin-1beta (IL-1beta) are important clinical prognostic markers in ICU septic patients. The goal of the study was to determine whether continuous venovenous haemofiltration (CWH), using an AN69 haemofilte, leads to elimination of PCT, TNFalpha, IL-6 and IL-1beta in 13 septic patients with multi-organ failure. At the start of haemofiltration (0), 6 and 12 hours the mean afferent plasma concentration +/- SD of PCT (10.1 +/- 9.1, 7 +/- 6, 5.9 +/- 5.7 ng/ml), IL-6 (804.6 +/- 847.6, 611.7 +/- 528.4, 575.2 +/- 539.2 pg/ml), and that of TNFalpha (4.5 +/- 2.6, 4 +/- 3.1, 3.8 +/- 2.9 pg/ml) significantly declined during CVVH. ⋯ The plasma clearance of PCT, IL-6 and TNFalpha significantly decreased after 12 hours as a result of a decline in the adsorptive elimination of the mediators due to progressive membrane saturation. We demonstrated that if PCT, IL-6 and TNFalpha are used as clinical prognostic markers in septic patients who are treated with CWIH using an AN69 membrane, one should be aware that their plasma level could be modified by the therapy. In addition CWH could represent an appropriate tool to remove a broad spectrum of proinflammatory mediators, if such removal is required in septic patients.
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All female members and a randomly selected group of male members of the Australian Society of Anaesthetists (n = 488) were surveyed by questionnaire as part of a broader study of gender issues in anaesthesia. This paper reports on reasons for career choice and the importance of role models. Responses were received from 199 women and 98 men (60.9% of those surveyed), representing all States and one Territory. ⋯ Other important factors in career choice were the application of physiology and pharmacology in patient care, practical and procedural aspects of practice, and chance. A majority of women (56%) and men (55%) named specific role models who were influential and encouraging in their choice. These results are similar to those of other studies.
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Anaesth Intensive Care · Jun 2002
Comparative StudyImplementation and evaluation of guidelines for preoperative testing in a tertiary hospital.
The aim of this study was to determine the extent of unnecessary investigation performed as part of the preoperative preparation of elective surgical patients in a teaching hospital and to audit the effect of guidelines and education designed to reduce unnecessary investigation. Guidelines were developed for preoperative anaesthetic investigation for elective surgical procedures in patients over one year of age according to internationally accepted criteria, with some adjustment for local differences in patient morbidity. Forrms outlining these criteria were placed in all operating theatres and anaesthetists were asked to determine whether tests performed were indicated or not, according to these criteria, over a two-week period, in each patient undergoing elective surgery. ⋯ The audit was repeated six months later and results compared. The incidence of over-investigation decreased from 13.8% to 11.6% (P = 0.03) without a significant increase in under-investigation (0.7 v 1.0%; P = 0.2). This study highlights the incidence of unwarranted screening tests in patients presenting for elective surgery and the role of protocols and ongoing education in reducing this incidence.