Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2004
Blood usage in an Australian intensive care unit: have we met best practice goals?
The transfusion of blood products, especially red cell concentrates, in critically ill patients is controversial and benefits of red cell concentrate transfusion in these patients have not been clearly demonstrated. We performed a prospective observational study to compare best evidence to actual practice of red cell concentrate and other blood product administration in an intensive care unit (ICU) in a university-associated tertiary hospital. All primary admissions during a 28-day period were included in the study and data collected included transfusion of red cells and blood products, patient demographics and ICU and hospital outcome. ⋯ Univariate analysis showed no significant difference in mortality between patients who did or did not receive red cell concentrate transfusion (P = 0.17). However, red cell concentrate transfusion was associated with a reduced adjusted mortality both in ICU (OR 0.13, 95% CI 0.02-0.73) and in hospital at 28 days (OR 0.10, 95% CI 0.02-0.58). The low red cell concentrate and blood product usage in our ICU were consistent with restrictive transfusion practice and selective red cell concentrate transfusion was associated with reduced mortality.
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Anaesth Intensive Care · Dec 2004
Comparative StudyDexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: haemodynamic effects and efficacy.
We investigated the haemodynamic effects and the efficacy of a continuous infusion of dexmedetomidine without a loading dose in 50 patients having had cardiac surgery (n = 33), complex major surgery (n = 9) and multiple trauma (n = 8). The mean age was 60 (+/- 16) years, and the mean APACHE II score was 13 (+/- 5). Dexmedetomidine was commenced at an initial rate of 0.2 to 0.4 microg/kg/h (depending on whether anaesthetic or sedative agents had already been used) and rescue analgesia and sedation was administered with morphine and midazolam respectively. ⋯ The systolic blood pressure fell from 125 (+/- 22) mmHg to a low of 112 (+/- 20) mmHg at 1.5 hours with minimal change afterwards. Dexmedetomidine was an effective sedative and analgesic in this group of complex surgical and trauma patients with pronounced benefit in the cardiac surgery group. Omitting the loading dose avoided undesirable haemodynamic effects without compromising sedation and analgesia.
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Anaesth Intensive Care · Dec 2004
Comparative StudyAn evaluation of the relative efficacy of an open airway, an oxygen reservoir and continuous positive airway pressure 5 cmH2O on the non-ventilated lung.
The aim of this study, during one-lung ventilation, was to evaluate if oxygenation could be improved by use of a simple oxygen reservoir or application of 5 cmH2O continuous positive airway pressure (CPAP) to the non-ventilated lung compared with an open airway. Twenty-three patients with lung malignancy, undergoing thoracotomy requiring at least 60 minutes of one-lung ventilation before lung lobe excision, were studied. After routine induction and establishment of one-lung ventilation, the three treatments were applied in turn to the same patient in a sequence selected randomly. ⋯ This overall difference was not quite significant (P = 0.058, paired ANOVA), but comparison of the pairs showed that there was a significant better oxygenation only with the CPAP compared to the reservoir treatments (t = 2.52, P = 0.021). While the effect on the surgical field was not apparent in most patients, in one patient surgery was impeded during CPAP. Our results show that the use of a reservoir does not give oxygenation better than an open tube, and is less effective than the use of CPAP 5 cmH2O on the non-ventilated lung during one-lung ventilation.
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Anaesth Intensive Care · Dec 2004
Comparative StudyCost calculation and prediction in adult intensive care: a ground-up utilization study.
The ability of various proxy cost measures, including therapeutic activity scores (TISS and Omega) and cumulative daily severity of illness scores, to predict individual ICU patient costs was assessed in a prospective "ground-up" utilization costing study over a six month period in 1991. Daily activity (TISS and Omega scores) and utilization in consecutive admissions to three adult university associated ICUs was recorded by dedicated data collectors. Cost prediction used linear regression with determination (80%) and validation (20%) data sets. ⋯ Without the Omega score, predictors were age, summed APACHE III score and ICU length of stay; determination R2, 0.73; validation 0.73. In non-survivors, predictors were age and ICU length of stay (plus interaction), and Omega score (determination R2, 0.97; validation 0.91). Patient costs may be predicted by a combination of ICU activity indices and severity scores.
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Anaesth Intensive Care · Dec 2004
Case ReportsExtensive spinal epidural abscess associated with an unremarkable recovery.
Spinal epidural abscess is a rare complication of epidural catheter insertion, with an incidence reported to be as low as 0.02%, but with a high morbidity and mortality. This reflects the difficulty in diagnosis of the condition, as early symptoms and signs are usually non-specific with late neurological manifestations. ⋯ Early investigation with magnetic resonance imaging was effective in demonstrating an extensive epidural abscess involving the thoracic spine, with extension to the base of the skull and associated cord compression. Extensive multilevel laminectomies with thorough irrigation and washout of the epidural space were successful in treating this patient and preventing the development of permanent neurological sequelae.