Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2008
Hyperglycaemia upon onset of ICU-acquired bloodstream infection is associated with adverse outcome in a mixed ICU population.
This study aimed to assess whether a relationship exists between hyperglycaemia and outcome in a mixed cohort of critically ill patients with nosocomial bloodstream infection (BSI), and to evaluate patterns of blood glucose levels between survivors and non-survivors. A historical observational cohort study was conducted in the intensive care unit (ICU) of a tertiary care referral centre. One-hundred-and-thirty patients with a microbiologically documented ICU-acquired BSI (period 2003 to 2004) were included. ⋯ Multivariate logistic regression showed that APACHE II (P = 0.002), antibiotic resistance (P = 0.004) and hyperglycaemia (> or = 175 mg/dl) upon onset of BSI (P = 0.017) were independently associated with in-hospital mortality, whereas a history of diabetes (P = 0.041) was associated with better outcome. Hyperglycaemia (> or = 175 mg/dl) upon onset of ICU-acquired BSI is associated with worse outcome in a heterogeneous ICU population. Patterns of morning blood glucose levels have only limited value in the prediction of the individual course.
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Anaesth Intensive Care · Jan 2008
The use of epidural analgesia in a New Zealand tertiary hospital before and after publication of the MASTER study.
We audited the total number of perioperative epidural techniques performed at Christchurch Hospital, New Zealand, for three years, before and after The Lancet published the MASTER Anaesthesia Trial in 2002. We also looked specifically at the number of epidural anaesthetic and analgesic techniques performed in combination with general anaesthesia for colonic surgery over the same period. In both cases we found a statistically significant fall in epidural rate in the years after the publication (P < 0.001). A subsequent survey of local specialist anaesthetists, who have worked throughout this period, revealed the majority (75%) were knowingly performing fewer epidural techniques and that the findings of the MASTER Anaesthesia Trial had influenced their decisions.
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Anaesth Intensive Care · Jan 2008
Safety of percutaneous tracheostomy in obese critically ill patients: a prospective cohort study.
Obesity has been described as a relative contraindication for percutaneous tracheostomy. The objective of our study was to examine the safety and complications of percutaneous tracheostomy in obese patients. We conducted a prospective cohort study of all consecutive patients who underwent percutaneous tracheostomy at a tertiary medical-surgical intensive care unit between May 2004 and October 2005. ⋯ Major complications were significantly higher in obese patients (12% vs. 2%, P = 0.04), while the rate of minor complications was not significantly different between the two groups. There were no instances of death or pneumothorax, subcutaneous emphysema or need for surgical intervention during or in the postoperative period in either group. Our study suggests that percutaneous tracheostomy can be performed safely in the majority of obese patients.
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Anaesth Intensive Care · Jan 2008
Pre-existing cardiac disease, troponin I elevation and mortality in patients with severe sepsis and septic shock.
A prospective, observational study was undertaken to determine the frequency of troponin I elevation and the incidence of pre-existing cardiac disease in patients with severe sepsis and septic shock, and to determine their relationship to mortality. The setting was the surgical intensive care unit of a tertiary care medical centre. Sixty-six consecutive patients admitted with severe sepsis or septic shock requiring pulmonary artery catheterisation for haemodynamic monitoring were studied. ⋯ Troponin I elevation alone was not associated with increased mortality. We conclude that pre-existing cardiac disease and elevated troponin I are commonly found in surgical patients with severe sepsis and septic shock. In our study, pre-existing cardiac disease, and not troponin I elevation, was associated with increased mortality.