Anaesthesia and intensive care
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Anaesth Intensive Care · May 2008
Risk factors for treatment failure in patients with severe acute cardiogenic pulmonary oedema.
Intubation is necessary in 7 to 20% of patients with severe acute cardiogenic pulmonary oedema despite optimal treatment. This study evaluated the usefulness of parameters largely available in clinical practice to predict the need for intubation in a population of acute cardiogenic pulmonary oedema patients treated with medical therapy and continuous positive airway pressure. The present retrospective cohort study involved 142 patients with severe acute cardiogenic pulmonary oedema who were admitted to coronary care or the intensive care unit of a university hospital and were treated by an in-hospital protocol. ⋯ The rate of intubation according to this score ranged from 0% (score of 0) to 90% (score of 3). Our study found that simple parameters available in clinical practice are significantly associated with the need for intubation in acute cardiogenic pulmonary oedema patients treated with continuous positive airway pressure and medical therapy. A simple score to evaluate the need for endotracheal intubation is proposed.
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Anaesth Intensive Care · May 2008
Noradrenaline use is not associated with extubation failure in septic patients.
Standard clinical practice recommends minimal doses of vasoactive drugs during weaning of patients from mechanical ventilation. However there are currently no clinical data to inform clinicians about whether the use of noradrenaline during weaning predisposes to weaning failure. The objective of this study was to evaluate whether the necessity of the vasopressor noradrenaline in mechanically ventilated patients recovering from septic shock changed the extubation outcome. ⋯ Arterial blood gases and ventilatory and haemodynamic parameters were similar in all patients regardless of weaning success. We did not find that the use of noradrenaline at the time of weaning was associated with extubation failure. Low doses of noradrenaline may not preclude weaning from mechanical ventilation.
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Anaesth Intensive Care · May 2008
The Glostavent: evolution of an anaesthetic machine for developing countries.
The sophisticated anaesthetic machines designed for use in modem hospitals are not appropriate for many parts of the developing world, as they are reliant on regular servicing by skilled engineers and an uninterrupted supply of electricity and compressed gases, which are not always available. The Glostavent has been designed specifically to meet the challenges faced by anaesthetists working in these countries. ⋯ Feedback from widespread use throughout the developing world over the last 10 years has led to significant improvements to the original design. This article describes the basic components of the original version and the modifications which have been introduced as a result of practical experience in the developing world.
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Anaesth Intensive Care · May 2008
Australian anaesthetists' practice of sedation for gastrointestinal endoscopy in adult patients.
A wide spectrum of practice in sedation for gastrointestinal endoscopy in adult patients is documented overseas, but a current profile of the practice of Australian anaesthetists is unavailable. We therefore surveyed 200 Fellows of the Australian and New Zealand College of Anaesthetists on the choice of drugs and monitoring, use of analgesic throat spray and prophylactic intravenous fluids and the depth of sedation for gastrointestinal endoscopy. Our response rate was 57% and endoscopy formed a significant part of most respondents' practices. ⋯ However over 20% of patients having gastroscopy or colonoscopy did not have non-invasive blood pressure monitoring. A maximum depth of sedation during which the patient was unresponsive to painful stimulation (commensurate with general anaesthesia) was targeted by 54% of respondents. Significant variations exist in the practice of sedation and monitoring for endoscopy in adult patients by anaesthetists in Australia.