Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2008
Immediate management of inadvertent dural puncture during insertion of a labour epidural: a survey of Australian obstetric anaesthetists.
Immediate management of inadvertent dural puncture during insertion of an epidural needle during labour is controversial and evidence to guide clinical practice is limited. We surveyed Australian obstetric anaesthetists by anonymous postal questionnaire. Of the 671 surveys sent, 417 (62%) were returned. ⋯ The most frequently reported reason for "usually inserting an ITC" was that this reduced the incidence (n = 120, 84%) and severity (n = 110, 77%) of post dural puncture headache. Increased frequency of ITC insertion was reported by respondents who practised more frequent sessions of obstetric anaesthesia, had fewer years of experience as a consultant anaesthetist and worked in a public hospital. The more widespread use of ITCs seems to be limited by safety concerns.
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Anaesth Intensive Care · Jan 2008
Bayesian approach to predict hospital mortality of intensive care readmissions during the same hospitalisation.
No specific prognostic model has been developed for patients readmitted to the intensive care unit (ICU) during the same hospitalisation. This study assesses the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II predicted mortality measured at the time of ICU readmission and whether incorporating information prior to the readmission will improve its performance to predict hospital mortality of patients readmitted to ICU during the same hospitalisation. A total of 602 readmissions during the same hospitalisation between 1987 and 2002 were identified. ⋯ In the subgroups of patients readmitted within seven days of discharge, the readmission APACHE II predicted mortality was also significantly better than the first admission APACHE II predicted mortality in discriminating between survivors and non-survivors (area under the receiver operating characteristic curve: 0.785 vs. 0.676, z statistic = 2.93; P = 0.003). Incorporating the first admission APACHE II predicted mortality to the readmission APACHE II predicted mortality, either by multilevel likelihood ratios or logistic regression, did not significantly improve its discrimination (area under the receiver operating characteristic curve: 0.792 vs. 0.785, z statistic = 0.52; P = 0.603). Our results suggested that information on prior ICU admission during the same hospitalisation is not as important as the severity of illness measured at the time of readmission in determining the mortality of intensive care readmissions during the same hospitalisation.