Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2007
Atrial fibrillation in a tertiary care multidisciplinary intensive care unit--incidence and risk factors.
Atrial fibrillation is a common arrhythmia in an intensive care unit. We performed a prospective observational study over a period of three months, to study the incidence, risk factors and outcome of patients who develop atrial fibrillation in a multidisciplinary intensive care unit. All patients above the age of 50 years were eligible. ⋯ Patients who developed atrial fibrillation required a longer period of mechanical ventilation and inotropic support. Multivariate logistic regression analysis showed age >75 years, APACHE II score >20 and sepsis at admission were independent predictors for development of atrial fibrillation in critically ill patients. Although atrial fibrillation by itself is unlikely to be the cause of higher mortality, it is likely to be a marker for increased mortality and resource utilisation in the intensive care unit.
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Anaesth Intensive Care · Oct 2007
Review Case ReportsLemierre's syndrome with septic shock caused by Fusobacterium necrophorum.
Fusobacterium necrophorum infections are rare. We report a 15-year-old male who presented with tachycardia, nausea, vomiting, diarrhoea and ankle pain. He rapidly deteriorated requiring ventilation and vasopressors. ⋯ Fusobacterium necrophorum was identified in blood culture on day nine. The patient recovered with antibiotics and surgical interventions for empyema and septic arthritis. Fusobacterium necrophorum should be a suspected pathogen in septic shock complicated by metastatic abscess formation.
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Anaesth Intensive Care · Oct 2007
ReviewA clinician's guide to predicting fluid responsiveness in critical illness: applied physiology and research methodology.
Intravenous fluid administration is often used in critical care with the goal of improving haemodynamics and consequently tissue perfusion and oxygen delivery. While inotropic and vasoactive drugs are often necessary to correct haemodynamic instability, resuscitation usually begins with fluid therapy. As fluid challenge can result in clinical deterioration, the ability to predict haemodynamic response is desirable. ⋯ Furthermore, an improved understanding of these principles should assist the clinician in appraising published data, which has been characterised by significant methodological differences. This review aims to assist the clinician by detailing the physiological principles that underlie the prediction of fluid responsiveness in the critically ill. In addition, the potential importance of methodological differences in the cutrent literature will be considered.
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Anaesth Intensive Care · Oct 2007
Randomized Controlled Trial Comparative StudyEffects of reduction of the caudal morphine dose in paediatric circumcision on quality of postoperative analgesia and morphine-related side-effects.
This study compared the efficacy and adverse effects of three low doses of morphine (10, 15 and 30 microg x kg(-1)) for caudal epidural analgesia in children undergoing circumcision. A total of 135 boys undergoing out-patient circumcision were randomly assigned to receive 10, 15 or 30 microg x kg(-1) of caudal morphine. Anaesthesia was induced and maintained with propofol. ⋯ Pruritus occurred in 8.9%, 11% and 15.6% in the 10, 15 and 30 microg.kg(-1) groups but was localised and did not require treatment. This study was not powered to assess concerns that low dose epidural morphine may rarely be associated with delayed apnoea and is therefore considered unsuitable for outpatient use in many centres. Increases in caudal morphine dose above 10 microg.kg1 produce some 'paracetamol sparing' but no improvement in analgesia, some pruritus and a significant increase in nausea and vomiting.
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Anaesth Intensive Care · Oct 2007
Case ReportsInspiratory muscle training to enhance weaning from mechanical ventilation.
This report describes the use of specific inspiratory muscle training to enhance weaning from mechanical ventilation in a patient who had failed conventional weaning strategies. A 79-year-old man remained ventilator-dependent 17 days following laparotomy. ⋯ By day 27, mechanical ventilation was no longer required. Inspiratory muscle training can be implemented effectively in the difficult to wean patient and should be considered for patients who have failed conventional weaning strategies.