Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2011
Review Meta AnalysisC-reactive protein as a predictor of mortality in critically ill patients: a meta-analysis and systematic review.
C-reactive protein is a marker of inflammatory response and has been widely investigated in cardiovascular and infectious diseases, especially to monitor therapeutic success. However, its role as a predictor of clinical outcome in critically ill patients remains uncertain and controversial. The objective of this study was to investigate the predictive value of C-reactive protein in critically ill patients. ⋯ The subgroup analysis showed that the weighted mean difference in early (within 48 hours) C-reactive protein levels between survivors and non-survivors was not significantly different, in contrast to the late (beyond 48 hours) C-reactive protein level. This was significantly greater in non-survivors with a weighted mean difference of 63.80 mg/l (95% confidence interval 35.67 to 91.93). Our systematic review shows that while the early C-reactive protein concentration is not a good predictor of survival in critically ill patients, the late C-reactive protein concentration may help to identify patients who are at risk of death.
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Anaesth Intensive Care · Sep 2011
Experience with high frequency oscillation ventilation during the 2009 H1N1 influenza pandemic in Australia and New Zealand.
During the 2009 H1N1 pandemic, large numbers of patients had severe respiratory failure. High frequency oscillation ventilation was used as a salvage technique for profound hypoxaemia. Our aim was to compare this experience with high frequency oscillation ventilation during the 2009 H1N1 pandemic with the same period in 2008 by performing a three-month period prevalence study in Australian and New Zealand intensive care units. ⋯ Survival rates were comparable to published extracorporeal membrane oxygenation outcomes. High frequency oscillation ventilation was used successfully as a rescue therapy for severe respiratory failure. High frequency oscillation ventilation was only available in a limited number of intensive care units during the H1N1 pandemic.
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All chronic pain was once acute, but not all acute pain becomes chronic. The transition of acute postoperative pain to chronic post surgical pain is a complex and poorly understood developmental process. ⋯ In future, the increasing understanding of genetic factors and the transitional mechanisms involved may reveal important clues to predict which patients will go on to develop chronic pain. This may assist the development of appropriate interventions affecting not only the individual concerned, but also ultimately the community at large.
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Anaesth Intensive Care · Sep 2011
The association between intraoperative electroencephalogram-based measures and pain severity in the post-anaesthesia care unit.
This observational study aimed to identify simple electroencephalogram indices of inadequate intraoperative opioid-mediated nociceptive blockade and to compare these indices with routinely used clinical predictors of severe postoperative pain in adults. Intraoperative trend and waveform data (electrocardiogram, pulse oximetry and electroencephalogram) were collected, pain intensity in the post-anaesthesia care unit was quantified using an 11-point Verbal Rating Score, and opioid administration was recorded. ⋯ Fifty-two patients had moderate or severe pain (Verbal Rating Score > or = 5). State entropy was lower (46.5 +/- 2.9 vs 43.1 +/- 1.9, P = 0.04) and spindle-like activity higher (0.42 +/- 0.03 vs 0.50 +/- 0.02, P = 0.03) in the moderate/severe pain group. [corrected] These findings suggest that there is a modest association between electroencephalogram measures near the end of surgery and the severity of postoperative pain.
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Anaesth Intensive Care · Sep 2011
ReviewAcute pain management in opioid-tolerant patients: a growing challenge.
In Australia and New Zealand, in parallel with other developed countries, the number of patients prescribed opioids on a long-term basis has grown rapidly over the last decade. The burden of chronic pain is more widely recognised and there has been an increase in the use of opioids for both cancer and non-cancer indications. While the prevalence of illicit opioid use has remained relatively stable, the diversion and abuse of prescription opioids has escalated, as has the number of individuals receiving methadone or buprenorphine pharmacotherapy for opioid addiction. ⋯ Discharge planning should commence at an early stage and may involve the use of a 'Reverse Pain Ladder' aiming to limit duration of additional opioid use. Legislative requirements may restrict which drugs can be prescribed at the time of hospital discharge. At all stages, there should be appropriate and regular consultation and liaison with the patient, other treating teams and specialist services.