Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2010
The role of admission surveillance cultures in patients requiring prolonged mechanical ventilation in the intensive care unit.
We undertook a prospective observational cohort study in intensive care unit (ICU) patients requiring mechanical ventilation for four days or more to evaluate normal and abnormal bacterial carriage on admission detected by surveillance cultures of throat and rectum. We assessed the importance of surveillance and diagnostic cultures for the early detection of resistance to third generation cephalosporins employed as the parenteral component of the selective decontamination of the digestive tract. Finally, we sought the risk factors of abnormal carriage on admission to the ICU. ⋯ The knowledge of carriage on admission using surveillance cultures may help intensivists to identify patients with abnormal carriage on admission and resistant bacterial strains at an early stage even when diagnostic samples are negative. Third generation cephalosporins covered admission flora in about 80% of the enrolled population and were modified in patients with abnormal flora who received antibiotic therapy before ICU admission. Our finding of overgrowth present on admission may justify the immediate administration of enteral antimicrobials.
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Anaesth Intensive Care · Mar 2010
Case ReportsCerebral flow pattern monitoring by transcranial Doppler during cardiopulmonary resuscitation.
We describe the transcranial Doppler pattern during a period of cardiopulmonary resuscitation in a patient undergoing a transcatheter off-pump aortic valve implantation. Transcranial Doppler of the middle cerebral artery flow was measured as a part of a separate ongoing study. The patient developed a cardiac arrest during deployment of the valve prosthesis. ⋯ After increasing the depth of external cardiac massage, the cerebral flow pattern improved to produce sufficient diastolic flow. The transcranial Doppler provided additional information during cardiopulmonary resuscitation, which was helpful in clinical management. The use of transcranial Doppler may be helpful for other cardiac procedures where cerebral malperfusion may occur.
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Anaesth Intensive Care · Mar 2010
Assessment of a cardiac output device using arterial pulse waveform analysis, Vigileo, in cardiac surgery compared to pulmonary arterial thermodilution.
Many devices are available to assess cardiac output (CO) in critically ill patients and in the operating room. Classical CO monitoring via a pulmonary artery catheter involves continuous cardiac output (CCO) measurement. The second generation of Flotrac/Vigileo monitors propose an analysis of peripheral arterial pulse waves to calculate CO (APCO) without calibration. ⋯ Large inter-individual variability does exist. During cardiac surgery and after leaving the operating room, Vigileo is not clinically equivalent to continuous thermodilution by pulmonary artery catheter Nevertheless, the connection between CCO and ICO relates the difference between APCO and CCO more to the different algorithms used. Further efforts should be concentrated on assessing the ability of this device to track changes in cardiac output.
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Anaesth Intensive Care · Mar 2010
A retrospective observational study examining the admission arterial to end-tidal carbon dioxide gradient in intubated major trauma patients.
Major trauma patients who are intubated and ventilated are exposed to the potential risk of iatrogenic hypercapnic and hypocapnic physiological stress. In the pre-hospital setting, end-tidal capnography is used as a practical means of estimating arterial carbon dioxide concentrations and to guide the adequacy of ventilation. In our study, potentially deleterious hypercapnia (mean 47 mmHg, range 26 to 83 mmHg) due to hypoventilation was demonstrated in 49% of 100 intubated major trauma patients arriving at a major Australian trauma centre. ⋯ However in this study, scene and arrival patient hypoxia was more predictive of hypoventilation and an increased arterial to end-tidal carbon dioxide gradient than physiological markers of shock. Greater vigilance for hypercapnia in intubated trauma patients is required. Additionally, a larger study may confirm that lower end-tidal carbon dioxide levels could be safely targeted in the pre-hospital and emergency department ventilation strategies of the subgroup of major trauma patients with scene hypoxia.
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Anaesth Intensive Care · Mar 2010
Effects of skin traction on cross-sectional area of the internal jugular vein in infants and young children.
Internal jugular veins (IJV) are commonly used to obtain central venous access. However percutaneous cannulation of the IJVis difficult in infants and young children because of its diminutive size. The aim of this study was to evaluate the effect of skin traction on the cross-sectional area of the IJV in anaesthetised infants (younger than one year) and young children (one to six years) using ultrasound. ⋯ The measurements were made after the induction of anaesthesia with patients in the supine position and with positive pressure ventilation. Skin traction increased the maximum cross-sectional area of the IJV by 39.9 +/- 29.6% in infants and by 33.8 +/- 21.9% in children (P < 0.01). This increase might facilitate easier and safer IJV cannulation in infants and children.