Anaesthesia and intensive care
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Anaesth Intensive Care · May 2009
Perioperative mortality risk score using pre- and postoperative risk factors in older patients.
We developed a risk score for 30-day postoperative mortality: the Perioperative Mortality risk score. We used a derivation cohort from a previous study of surgical patients aged 70 years or more at three large metropolitan teaching hospitals, using the significant risk factors for 30-day mortality from multivariate analysis. We summed the risk score for each of six factors creating an overall Perioperative Mortality score. ⋯ The Hosmer-Lemeshow test (P = 0.35) indicated good calibration in the validation cohort. The Perioperative Mortality score is straightforward and may assist progressive risk assessment and management during the perioperative period. Risk associated with surgical complexity and urgency could be added to this baseline patient factor Perioperative Mortality score.
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Acute right ventricular (RV) failure has until recently received relatively little attention in the cardiology, critical care or anaesthesia literature. However, it is frequently encountered in cardiac surgical cases and is a significant cause of mortality in patients with severe pulmonary hypertension who undergo non-cardiac surgery. RV dysfunction may be primarily due to impaired RV contractility, or volume or pressure overload. ⋯ Levosimendan is a promising new inotrope for the treatment of RV failure, although its role in comparison to older agents such as dobutamine, adrenaline and milrinone has yet to be determined. This is also the case for the use of vasopressin as an alternative pressor to noradrenaline. If all else has failed, mechanical support of the RV should be considered in selected cases.
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Anaesth Intensive Care · May 2009
Comparative StudyLaboratory validation of the M-COVX metabolic module in measurement of oxygen uptake.
A practical method of breath-by-breath monitoring of metabolic gas exchange has previously been developed by GE Healthcare and can now be easily incorporated into existing anaesthetic and critical care monitoring (M-COVX). Previous research using this device has shown good accuracy and precision between the M-COVX measurements and a traditional measurement of gas uptake at the mouth and also against the reverse Fick method during cardiac surgery and critical care, but its accuracy in the paediatric situation and across a range of ventilatory settings awaits validation. We tested the M-COVX metabolic monitor in the laboratory comparing its measurement to a traditional Haldane transformation across a wide range of oxygen consumption values, from 50 ml/minute to just under 300 ml/minute, typical of those expected in anaesthetised adults and children. ⋯ Excellent linearity was found, by y = 0.96x + 0.5 ml/minute, r = 0.99. The device showed acceptable robustness to ventilatory changes examined, including changes in respiratory rate, I:E ratio, FiO2 up to 75% and simulated spontaneous breathing. However any induced leak from around the simulated endotracheal tube caused a significant error in paediatric scenarios.
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Anaesth Intensive Care · May 2009
Comparative StudyA comparison of eosinopenia and C-reactive protein as a marker of bloodstream infections in critically ill patients: a case control study.
Diagnosis of bloodstream infections in critically ill patients is difficult. This case control study involved a total of 22 patients with confirmed bloodstream infections and 44 concurrent controls from an intensive care unit in Western Australia. We aimed to assess whether eosinopenia and C-reactive protein are useful markers of bloodstream infections in critically ill patients. ⋯ C-reactive protein concentration was, however the only significant predictor in the multivariate analysis (odds ratio 1.21 per 10 mg/l increment, 95% CI 1.01 to 1.39, P = 0.007). C-reactive protein concentration appears to be a better marker of bloodstream infections than eosinopenia in critically ill patients. A large prospective cohort study is needed to assess whether eosinopenia is useful in addition to C-reactive protein concentrations as a marker of bloodstream infections.
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Anaesth Intensive Care · May 2009
Case ReportsContinuous spinal analgesia after extensive lumbar spine surgery.
A 77-year-old male underwent L-1 to S-1 spine decompression and fusion from L-3 to S-1. A 25 G spinal catheter was placed intraoperatively and bupivacaine 1.25 mg/ml, fentanyl 2 microg/ml and morphine 3 microg/ml infused. ⋯ Continuous spinal analgesia was effective after extensive spinal surgery. The risks of post-dural puncture headache, infection of wound and/or meninges and the optimum drug doses and combinations are yet to be quantified in this setting.