Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2011
Intensivists' opinion and self-reported practice of oxygen therapy.
Intensivists frequently prescribe oxygen therapy for critically ill patients, however little is known about how intensivists manage oxygen therapy, or what factors influence their decisions. We surveyed intensivists listed on the Australian and New Zealand Intensive Care Society Clinical Trials Group database to investigate how intensivists report their approach to the monitoring, prescription and management of risks associated with oxygen therapy. The response rate was 60.4% (99/164 intensivists). ⋯ For a ventilated acute respiratory distress syndrome patient, 36.8% (36/98 respondents) would not allow an SaO2 of < 85% for < or =15 minutes, and 27.6% (27/96 respondents) would not allow an SaO2 < 90% for > 24 hours. Respondents with < or = 14 years of specialty practice were more likely to specify the oxygen delivery device to be used (P = 0.014). Recognising the factors that currently influence oxygen administration decisions is a necessary prelude to the potential conduct of interventional studies, as well as for the development of better guidance for oxygen therapy in critical care.
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Anaesth Intensive Care · Jan 2011
Performance of sequential organ failure assessment, logistic organ dysfunction and multiple organ dysfunction score in severe sepsis within Chinese intensive care units.
This study assessed the performance of Sequential Organ Failure Assessment, Logistic Organ Dysfunction Score and Multiple Organ Dysfunction Score in outcome prediction in severe sepsis. A total of 528 consecutive patients with a diagnosis of severe sepsis were enrolled from two surgical intensive care units of university hospitals in China. Clinical and laboratory data of patients were collected and admission and maximum values of each scoring system were calculated. ⋯ Brier Scores, indicating the overall performance of the scores, were 0.18, 0.17 and 0.22 for admission Sequential Organ Failure Assessment, Logistic Organ Dysfunction Score and Multiple Organ Dysfunction Score respectively, and 0.12, 0.10 and 0.15 for their maximum counterparts respectively. This study found good performance of both admission Sequential Organ Failure Assessment and Logistic Organ Dysfunction Score in severe sepsis, and a slightly weaker performance of admission Multiple Organ Dysfunction Score. Since poor calibration was observed in Logistic Organ Dysfunction Score and Multiple Organ Dysfunction Score, we suggest further study of customisation of these scores in critical illness with severe sepsis.
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Airway complications are a leading cause of morbidity and mortality in anaesthesia. Effective management of a difficult airway requires the timely availability of suitable airway equipment. ⋯ TG4 [2010] will be reviewed at the end of one year and thereafter every five years or more frequently if necessary. The current paper is reproduced directly from the Background Paper (TG4 BP [2010]).
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Anaesth Intensive Care · Jan 2011
Long-term follow-up of patients with post-traumatic refractory high intracranial pressure treated with lumbar drainage.
Drainage of cerebrospinal fluid by means of external lumbar drainage (ELD) is controversial in the adult population with traumatic brain injury. We report our experience with ELD in the treatment of post-traumatic high intracranial pressure (ICP) and the results of the long-term follow-up in these patients. We undertook clinical evaluation of 30 patients with traumatic brain injury and high ICP treated with second-tier measures or with first-tier measures if second-tier measures were contraindicated. ⋯ Long-term outcome was favourable (good recovery or moderate disability) in 62% of the patients studied. The use of ELD resulted in a marked decrease in ICP These patients presented a good outcome in 62% of the cases in the long-term evaluation. Few complications related with ELD use were noted.
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Anaesth Intensive Care · Jan 2011
Concentration-dependent effect of hypocalcaemia on mortality of patients with critical bleeding requiring massive transfusion: a cohort study.
Mortality of patients with critical bleeding requiring massive transfusion is high. Although hypothermia, acidosis and coagulopathy have been well described as important determinants of mortality in patients with critical bleeding requiring massive transfusion, the risk factors and outcome associated with hypocalcaemia in these patients remain uncertain. This cohort study assessed the relationship between the lowest ionised calcium concentration during the 24-hour period of critical bleeding and the hospital mortality of 352 consecutive patients, while adjusting for diagnosis, acidosis, coagulation results, transfusion requirements and use of recombinant factor VIIa. ⋯ In conclusion, ionised calcium concentrations had an inverse concentration-dependent relationship with mortality of patients with critical bleeding requiring massive transfusion. Both acidosis and the amount of fresh frozen plasma transfused were the main risk factors for severe hypocalcaemia. Further research is needed to determine whether preventing ionised hypocalcaemia can reduce mortality of patients with critical bleeding requiring massive transfusion.