Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2012
Association between perioperative glucose levels and adverse outcomes in infants receiving open-heart surgery with cardiopulmonary bypass for congenital heart disease.
There is no consensus that hyperglycaemia is an independent predictor of morbidity-mortality in children. This retrospective observational study aimed to assess the association between abnormal perioperative glucose levels and adverse outcomes in infants receiving open-heart surgery with cardiopulmonary bypass. The records of a total of 233 infants who underwent cardiopulmonary bypass for a variety of congenital cardiac procedures between January and December 2010 were reviewed. ⋯ After adjusting for other potential variables, lower weight at surgery, longer surgery time and hospital length-of-stay are the independent predictors of morbidity-mortality. Our findings suggest that perioperative hyperglycaemia and mild transient hypoglycaemia do not appear to be detrimental to infants with congenital heart disease, although we did not assess neurological outcomes. Nevertheless, due to the limitations of the retrospective design of this study and its limited power, more thorough clinical randomised controlled trials are needed.
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Anaesth Intensive Care · Sep 2012
Case ReportsThe tyranny of distance: telemedicine for the critically ill in rural Australia.
A case of severe sepsis with multi-organ failure needing complex support was deemed too ill for transfer to a major centre. Telemedicine allowed direct patient review, collaborative advice and collegial support with maintained healthcare standards while avoiding long distance transfer from his home and family.
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Anaesth Intensive Care · Sep 2012
Stroke volume variation as a predictor of fluid responsiveness in patients undergoing airway pressure release ventilation.
We investigated the effectiveness of stroke volume variation (SVV) shown by the Vigileo-FloTrac™ system (Edwards Lifesciences, Irvine, CA) to predict fluid responsiveness in patients undergoing airway pressure release ventilation (APRV). All 80 patients mechanically ventilated in the intensive care unit of our hospital from April to November 2010 were included in this study. After starting APRV, Ringer's lactate solution was administered for 30 minutes. ⋯ The areas under the ROC curves were 0.793 for SVV (95% confidence interval: 0.709-0.877) and 0.442 for central venous pressure (95% confidence interval: 0.336-0.549), which were significantly different (P<0.05). The optimal threshold value of SVV to discriminate between responders and nonresponders was 14% (sensitivity: 78.9%; specificity: 64.3%). We found that SVV was able to predict fluid responsiveness in patients undergoing APRV with acceptable levels of sensitivity and specificity.
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Anaesth Intensive Care · Sep 2012
Case ReportsContribution of morphine and morphine-6-glucuronide to respiratory depression in a child.
A morphine plasma concentration/respiratory rate relationship has been described for both adults and children although that of its metabolite, morphine-6-glucuronide, remains uncertain. We describe this relationship in a child with end-stage renal failure who received repeat morphine administration over two days. ⋯ Failure to clear morphine-6-glucuronide renally led to respiratory depression episodes occurring later than those predicted by modelling morphine levels only. These findings support the use of alternative analgesics (e.g. fentanyl) that are cleared by non-renal pathways and have no active metabolites in patients with end-stage renal disease.