Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2004
Review Case ReportsSuccessful use of ECMO in adults with life-threatening infections.
Two cases of critically ill patients who received extracorporeal membrane oxygenation (ECMO) using different forms of circuitry and for different indications are presented. Both patients had life-threatening infections with septic shock and were not able to be supported by conventional means. ⋯ The second patient had psittacosis and received venovenous ECMO for respiratory failure. We discuss the expanding indications for this technology and the role it has to play in adult intensive care.
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Anaesth Intensive Care · Oct 2004
Comparative Study Clinical TrialAdjustment of anaesthesia depth using bispectral index prolongs seizure duration in electroconvulsive therapy.
Electroconvulsive therapy (ECT) under propofol anaesthesia induces relatively shorter seizures compared to barbiturate anaesthesia. Since significant correlation between seizure duration and bispectral index (BIS) value immediately before electrical stimulus has been reported among patients, adjustment of anaesthesia depth as determined by BIS may be effective in obtaining a longer seizure length. In the present study, we examined this hypothesis in those patients whose muscular seizure duration was less than 40s. ⋯ Seizure duration measured by muscle movement was 31+/-5 s when the stimulus was delivered without waiting and 46+/-10 s when delivered after waiting. There was a significant difference in seizure duration between the two treatments (P<0.01). Waiting for a recovery in BIS value before electrical stimulation can prolong seizure duration.
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Anaesth Intensive Care · Oct 2004
Comparative StudyNasopharyngeal oxygen in adult intensive care--lower flows and increased comfort.
Nasopharyngeal oxygen therapy, the delivery of supplementary oxygen into the nasopharynx via a fine catheter placed through the nose, is a simple technique used in postoperative anaesthetic care units and paediatric intensive care, but never described in the setting of adult intensive care. In a prospective crossover design, we compared nasopharyngeal oxygen therapy with semi-rigid plastic mask (Hudson Mask) in 50 unintubated adult patients receiving supplemental oxygen. We measured oxygen flow rate to achieve cutaneous saturations 93 to 96%, and patient comfort by visual analogue score. Nasopharyngeal oxygen therapy consumed significantly less oxygen than mask administration (3.0+/-0.9 vs 6.7+/-2.1 l/min, P<0.001) and was associated with significantly higher comfort than the mask (7.5+/-1.6 cm vs 5.2+/-1.8, P<0.001).
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Anaesth Intensive Care · Oct 2004
Case ReportsRate-dependent left bundle branch block during anaesthesia.
Rate-dependent left bundle branch block during general anaesthesia is rare. Its occurrence makes electrocardiographic diagnosis of acute myocardial ischaemia or infarction difficult. ⋯ We present a case of rate-dependent left bundle branch block in a patient with no previous history of ischaemic heart disease. Carotid sinus massage resulted in a decrease in heart rate and reversion to normal sinus rhythm.
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Anaesth Intensive Care · Oct 2004
Comparative StudyNight-shift discharge from intensive care unit increases the mortality-risk of ICU survivors.
Intensive Care (ICU) survivors discharged from ICU to the general ward at night have a higher mortality. We sought to clarify which factors, including night-shift discharge, influence outcome following ICU discharge in a metropolitan hospital, using a cohort study of critically-ill patients between 1/1/1999-30/4/2003. Patients were excluded from analysis if they (a) died in ICU, (b) were transferred to another hospital, (c) had an ICU length of stay <8 hours, or (d) age <16 years. Logistic regression was used to derive a predictive model based on the following variables: patient demographics, severity of illness following ICU admission (APACHE II mortality-risk, p(m)), final diagnosis, discharge timing including premature or delayed (>4 hours) ICU discharge, and "limitation of medical treatment" orders. The outcome measures were patient status at hospital discharge and ICU readmission rate. Of the 1870 ICU survivors, 92 (4.9%) died after discharge from ICU. Patients discharged to the ward during the night-shift (2200-0730 hours) had a higher APACHE II score and crude mortality. The difference in APACHE II p(m) did not reach statistical significance. No significant calendar or seasonal pattern was identified. Logistic regression identified night-shift discharge (RR=1.7; 95% CI 1.03-2.9; P=0.03), limited medical treatment order (RR=5.1; 95% CI 2.2-12) and admission APACHE II p(m) (RR=3.3; 95% CI 1.3-7.6) as independent predictors of patient outcome following ICU transfer to the ward. ⋯ At the time of ICU discharge to the ward three factors are predictive of hospital outcome: timing of ICU discharge, limited medical treatment orders and initial illness severity.