Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2010
Ocular surface bacterial colonisation in sedated intensive care unit patients.
We investigated the time-dependent ocular surface bacterial colonisation of sedated patients hospitalised in an intensive care unit and aimed to evaluate whether proper topical antibiotic prophylaxis could prohibit corneal infection. The study lasted 12 months and included 134 patients undergoing sedation and mechanical respiratory support for various medical reasons. Patients hospitalised for less than seven days and those with pre-existing ocular surface pathology were excluded. ⋯ Infectious keratitis was prohibited in all cases. Ocular surface of long-term sedated patients was found to be colonised by various bacterial species and their isolation was closely associated with the time period of hospitalisation. The results of this study suggest that the early identification of ocular surface bacteria colonisation and the administration of topical antibiotics for prophylaxis can prohibit corneal infection in these patients.
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Anaesth Intensive Care · Jan 2010
Patient- and operator-related factors associated with successful Glidescope intubations: a prospective observational study in 742 patients.
The Glidescope Video Laryngoscope (Glidescope, Verathon Medical, Bothell, WA, U. S. A.) is a relatively new intubating device. ⋯ With regard to the level of anaesthesia training, only medical students were more likely to fail with the Glidescope. Success was not associated with previous experience in direct laryngoscopy. The lack of association with direct laryngoscopy experience and level of anaesthesia training (beyond student level) suggests that expertise with traditional airway tools is not necessary to become proficient with the Glidescope.
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Anaesth Intensive Care · Jan 2010
The effect of dexmedetomidine on agitation during weaning of mechanical ventilation in critically ill patients.
Ventilated patients receiving opioids and/or benzodiazepines are at high risk of developing agitation, particularly upon weaning towards extubation. This is often associated with an increased intubation time and length of stay in the intensive care unit and may cause long-term morbidity. Anxiety, fear and agitation are amongst the most common non-pulmonary causes of failure to liberate from mechanical ventilation. ⋯ Excluding unrelated clinical deterioration, 22 episodes (73.3%) achieved successful weaning from ventilation with a median (interquartile range) ventilation time of 70 (28 to 96) hours after dexmedetomidine infusion. Dexmedetomidine achieved rapid resolution of agitation and facilitated ventilatory weaning after failure of conventional therapy. Its role as first-line therapy in ventilated, agitated patients warrants further investigation.
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Anaesth Intensive Care · Jan 2010
Preoperative estimated glomerular filtration rate and RIFLE-classified postoperative acute kidney injury predict length of stay post-coronary bypass surgery in an Australian setting.
We investigated the influence of preoperative estimated glomerular filtration rate and postoperative acute kidney injury on outcomes after coronary bypass surgery in a local setting, with the focus on length of stay. A retrospective analysis of prospectively collected data for 3302 consecutive patients who underwent coronary artery bypass graft surgery (June 1997 through to January 2007) at St. Vincent's Public Hospital, Melbourne, was undertaken. ⋯ Hazard ratios also decreased as severity of postoperative acute kidney injury category increased, when compared to those with no acute kidney injury: risk 0.67 (0.58 to 0.77, P < 0.001), injury 0.52 (0.41 to 0.65, P < 0.001), failure 0.35 (0.20 to 0.60, P < 0.001). The increasing severity of preoperative renal dysfunction and postoperative acute kidney injury were associated with increased hospital length of stay. This has implications for resource use, informed consent and case selection.
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Anaesth Intensive Care · Jan 2010
Monitoring of extubated patients: are routine arterial blood gas measurements useful and how long should patients be monitored in the intensive care unit?
Restitution of respiratory support, which may include continuous positive airway pressure, non-invasive ventilation or reintubation, is needed in some patients post-extubation. We aimed to investigate whether serial arterial blood gas measurements done in the post-extubation period would help to identify such patients and to delineate the optimal post-extubation duration for close monitoring. We retrospectively analysed 115 consecutive adult patients who were extubated following successful spontaneous breathing trials in the medical intensive care unit, excluding patients who were extubated to immediate non-invasive ventilation. ⋯ Performing serial arterial blood gas measurements following extubation did not improve the detection rate or allow earlier detection of patient deterioration. Among the patients with pneumonia, restitution of respiratory support was required within 24 hours of extubation for 16 patients (80%) and after more than 49 hours for four patients. Serial arterial blood gas measurements at one and three hours after a planned extubation are not useful and patients originally intubated for pneumonia should be monitored post-extubation for at least 24 hours in the intensive care unit.