Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2009
Randomized Controlled Trial Comparative StudyThe performance of customised APACHE II and SAPS II in predicting mortality of mixed critically ill patients in a Thai medical intensive care unit.
The aim of this study was to evaluate and compare the performance of customised Acute Physiology and Chronic Health Evaluation HII (APACHE II) and Simplified Acute Physiology Score HII (SAPS II) in predicting hospital mortality of mixed critically ill Thai patients in a medical intensive care unit. A prospective cohort study was conducted over a four-year period. The subjects were randomly divided into calibration and validation groups. ⋯ The customised SAPS II showed good calibration in only the younger, postoperative and sepsis patients subgroups. The overall performance of the customised APACHE II was better than the customised SAPS II (Brier score 0.089 and 0.109, respectively). Our results indicate that the customised APACHE II shows better performance than the customised SAPS II in predicting hospital mortality and could be used to predict mortality and quality assessment in our unit or other intensive care units with a similar case mix.
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Anaesth Intensive Care · Sep 2009
Case ReportsContinuous venovenous haemodiafiltration for metformin-induced lactic acidosis.
A 74-year-old man with cardiac failure and renal impairment was admitted to the cardiothoracic intensive care unit with metformin-induced lactic acidosis and shock. He was successfully treated with high-dose (80 ml/kg/hour) continuous venovenous haemodiafiltration. Lactic acidosis is a known complication of metformin and is associated with a high mortality. The use of high-dose continuous venovenous haemodiafiltration for this condition has not previously been reported.
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Anaesth Intensive Care · Sep 2009
Comparative StudyThe influence of gender and experience on intubation ability and technique: a manikin study.
Female anaesthetists in early training commonly question whether their strength is adequate for tracheal intubation. This study investigated the influence of gender and experience on intubation ability and laryngoscopic technique. A manikin model and purpose-designed force-transducing laryngoscope was used to test three cohorts at different levels of experience (novice, intermediate and experienced males and females, n = 65) for the axial force and torque exerted, best laryngoscopic view obtained, success with and time for intubation and laryngoscopic technique. ⋯ With experience, the forces generated during intubation reduced and ability improved. Proximal laryngoscope grips (close to the blade) generated lower forces than distal grips. Female and male intubators did not differ in ability to intubate or in the forces they exerted during direct laryngoscopy.
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Anaesth Intensive Care · Sep 2009
Non-invasive assessment of the microcirculation in critically ill patients.
Sepsis is associated with abnormalities of muscle tissue oxygenation and of microvascular function. We investigated whether the technique of near-infrared spectroscopy can evaluate such abnormalities in critically ill patients and compared near-infrared spectroscopy-derived indices of critically ill patients with those of healthy volunteers. We studied 41 patients (mean age 58 +/- 22 years) and 15 healthy volunteers (mean age 49 +/- 13 years). ⋯ Furthermore, oxygen consumption rate was significantly lower in patients with septic shock than patients with SIRS. Reperfusion rate was significantly lower in patients with SIRS (336 +/- 141%/minute, P < 0.001), severe sepsis (257 +/- 150%/minute, P < 0.001) or septic shock (146 +/- 101%/minute, P < 0.001) than in healthy volunteers (713 +/- 223%/minute) and significantly lower in the septic shock than in the SIRS group. Near-infrared spectroscopy can detect tissue oxygenation deficits and impaired microvascular reactivity in critically ill patients, as well as discriminate among groups with different disease severity.
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Anaesth Intensive Care · Sep 2009
Case ReportsIn vivo evaluation of tissue microflow under combined therapy with extracorporeal life support and intra-aortic balloon counterpulsation.
Treatment with percutaneous extracorporeal mechanical assist devices provides the ultimate therapeutic option to improve the macrocirculation in patients suffering from refractory cardiac arrest, severe cardiogenic shock or during high-risk interventions. However, the flow in the smallest vessels in these critical periods is poorly understood but prognostically of high importance. ⋯ Our results show that intra-aortic balloon counterpulsation applied in addition to extracorporeal membrane oxygenation further improves the microflow. This in vivo finding supports pilot studies favouring the application of devices supporting cardiac output (extracorporeal membrane oxygenation) together with devices aimed at pulsatility (intra-aortic balloon pump).