Anaesthesia and intensive care
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Anaesth Intensive Care · May 2010
Clinical characteristics and outcomes of patients with obstructive sleep apnoea requiring intensive care.
We reviewed the clinical characteristics, required intervention and short- and long-term outcomes in obstructive sleep apnoea (OSA) patients requiring intensive care. A retrospective, single-centre, observational cohort study was undertaken in a multidisciplinary teaching medical and surgical intensive care unit. Adult patients with OSA (apnoea-hypopnoea index of 5 or higher) requiring intensive care from January 2000 to January 2005 were included. ⋯ The baseline polysomnographic data of the OSA patients were not correlated with their clinical features and outcomes in the intensive care unit. A more complicated clinical course and higher intensive care unit readmission rate were encountered in OSA patients admitted due to respiratory events. Further studies would be required to evaluate the efficacy of non-invasive ventilation for facilitation of extubation in OSA patients presenting with hypercapnic respiratory failure.
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Anaesth Intensive Care · May 2010
Intrahospital transfer of critically ill patients; a prospective audit within Flinders Medical Centre.
A prospective observational audit of 32 intrahospital transfers of critically ill patients was undertaken within Flinders Medical Centre. The aim was to assess the adherence of recommended staffing and equipment required during intrahospital transfer according to the "Minimum standards for intrahospital transport of critically ill patients" (PS39) published in 2003 by the Joint Faculty of Intensive Care Medicine, the Australian and New Zealand College of Anaesthetists and Australasian College for Emergency Medicine. ⋯ Oxygen saturation and blood pressure monitoring were present in 97%, heart rate monitoring in 90.5%, electrocardiogram monitoring in 84.5% and capnometry monitoring in 75% of the intrahospital transfers observed. Overall, 44% of transfers resulted in incident occurrence, many of which were preventable with careful planning and increased communication between staff Intensive care units are encouraged to continually evaluate their intrahospital transportation of critically ill patients and to identify system problems contributing to failure of adherence to the current guidelines.
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Anaesth Intensive Care · May 2010
The development and implementation of an obstetric cell salvage service.
Cell salvage in obstetric haemorrhage is now endorsed by a number of organisations. Most of the literature has focused on isolated case series and safety. We describe how cell salvage, including a quality assurance process conducted prior to clinical implementation, was introduced to our stand-alone obstetric hospital which had no previous experience of this technique. ⋯ We recommend that in units that already provide intraoperative cell salvage in a non-obstetric setting, extending the service into obstetric situations should be considered. Units that routinely care for high-risk obstetric patients should also consider the introduction of such a service. Post transfusion Kleihauer testing should be performed as soon as possible in Rhesus-negative mothers who deliver a Rhesus-positive foetus, so that appropriate anti-D prophylaxis can be administered.
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Anaesth Intensive Care · May 2010
Case ReportsExtracorporeal membrane oxygenation: an unusual cause of acute limb compartment syndrome.
Acute limb compartment syndrome is a surgical emergency associated with significant morbidity if not diagnosed promptly and treated effectively. We describe a case of severe and eventually lethal acute limb compartment syndrome, which complicated veno-arterial extracorporeal membrane oxygenation in a previously well young woman who had suffered an unexplained cardiac arrest. We recommend that intensive care units develop clinical practice guidelines for the use of extracorporeal membrane oxygenation therapy in order to minimise the risk of similar adverse events in the future.