Anaesthesia and intensive care
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Anaesth Intensive Care · May 2011
The relationship between blood lactate and survival following the use of adrenaline in the treatment of septic shock.
This prospective observational study evaluates the relationship between adrenaline, lactate and intensive care unit survival in septic shock. Forty patients requiring adrenaline therapy for a first episode of septic shock acquired > 24 hours after admission to the intensive care unit had blood lactate levels measured two-hourly over a 24-hour period. Adrenaline therapy was escalated until target mean arterial pressure was reached. ⋯ Peak lactate correlated with peak adrenaline (rho = 0.34, P = 0.032). Lactate index was the only independent predictor of survival after controlling for age and Acute Physiological and Chronic Health Evaluation II score (odds ratio 1.14, 95% confidence interval 1.03 to 1.26, P = 0.009). A high lactate following adrenaline administration may be a beneficial and appropriate response.
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Anaesth Intensive Care · May 2011
Case ReportsSuccessful treatment of peripartum massive pulmonary embolism with extracorporeal membrane oxygenation and catheter-directed pulmonary thrombolytic therapy.
Chronic thromboembolic pulmonary hypertension during pregnancy is uncommon but is associated with maternal mortality in excess of 35%. We report a case of decompensated thromboembolic pulmonary hypertension requiring emergency caesarean section and postpartum treatment with extracorporeal membrane oxygenation and thrombolytic therapy with urokinase. The use of extracorporeal membrane oxygenation, catheter-directed pulmonary thrombolytic therapy and other pulmonary vasodilators for management of this life-threatening disease is discussed.
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Anaesth Intensive Care · May 2011
Intrabronchial airway pressures in intubated patients during bronchoscopy under volume controlled and pressure controlled ventilation.
Bronchoscope insertion through an endotracheal tube increases airflow resistance. Constant tidal volume (T(v)) ventilation can be maintained by augmenting the inspiratory pressure, but increased outflow resistance cannot be compensated for. Air trapping distal to the tube may lead to higher airway pressures in volume controlled (VC) mode and reduced T(v) in pressure controlled (PC) mode. ⋯ In PC mode, peak airway pressure was unchanged and end-expiratory airway pressure increased from 9.5 cmH2O (7 to 10) to 10.5 cmH2O (9 to 18) (P = 0.017). Median T(v) was reduced from 673 ml (585 to 800) to 450 ml (408 to 560) (P = 0.012); median P(a)CO2 increased from 5.7 kPa to 6.5 kPa (P = 0.012). Using distal measurement, positive end-expiratory airway pressure increased markedly in VC mode but only marginally in PC mode after bronchoscope insertion.
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Anaesth Intensive Care · May 2011
Anaesthesia trainees' exposure to regional anaesthesia in an Australian tertiary adult teaching hospital.
The purpose of this study was to quantify the exposure of anaesthetic trainees to regional anaesthesia in an Australian tertiary adult teaching hospital. We reviewed data collected on all regional blocks performed by the anaesthetic department over a two-year period. The data was then broken down to give an estimate of the number of each block performed by each training year group. ⋯ The number of total blocks and the proportion of advanced blocks increased with increasing level of training while supervision declined. Trainees in the two regional fellowship positions (7% of the trainee pool) performed 42% of the 1374 blocks. Factors that may influence the exposure of trainees to regional anaesthesia and the assessment of competency are considered.
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Anaesth Intensive Care · May 2011
Rohrer's constant, K2, as a factor of determining inspiratory resistance of common adult endotracheal tubes.
The aim of the study was to calculate the in vitro inspiratory resistance (R(ETT)) of adult endotracheal tubes (ETT), via the end-inspiratory occlusion method, and to apply this method in vivo in order to estimate R(ETT) value in real time. By plotting R(ETT) over inspiratory flow (V) and calculating Rohrer's coefficients of linear and nonlinear resistance, K1 and K2 respectively, we determined the resistive behaviour of each ETT. Peak and plateau pressures were recorded at both proximal and distal sites of the ETT after applying a three-second occlusion under constant flow. ⋯ The intraluminal catheter increased R(ETT) No.7.0 by an average of 49%. Finally, ten patients with partially obstructed ETTs were tested and K2 in vivo constants found to be higher than their corresponding in vitro values (P value 0.00012). Therefore, knowing the performing size of an ETT may help the clinicians identify ETT obstruction and deal with weaning problems.