Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2013
Observational StudyTiming of blood transfusion in relation to ICU admission-a single centre audit.
There is growing concern that blood transfusion may be associated with adverse outcomes in critically ill patients. Timing of transfusion in relation to intensive care unit (ICU) stay may be important in designing and understanding transfusion studies. The objective of this study was to determine the timing of red blood cell transfusion in relation to admission to an Australian ICU and to describe associations with transfusion requirements. ⋯ There was no difference between transfused and non-transfused groups in either crude mortality or severity-adjusted mortality. In approximately one-third of ICU patients in our study transfusions occurred before admission to, and/or after discharge from, the ICU. This has implications for designing and interpreting transfusion studies in the ICU and requires confirmation in a multi-centre study.
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The primary objective of this survey was to investigate the prevalence of insomnia among anaesthetists in Hong Kong. The use of sleeping aids, factors associated with insomnia and the effect of insomnia on work performance were also studied. We surveyed all locally registered anaesthesia specialists and trainees by post. ⋯ However, it was not associated with the tendency to fall asleep at work. The results of this survey suggest that insomnia is a common problem among the anaesthetists of Hong Kong. By restricting the amount of on-call duty and improving relationships with supervisors, the prevalence of insomnia may be reduced and the quality of patient care improved.
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Anaesth Intensive Care · Nov 2013
Intraoperative hypothermia is associated with an increased intensive care unit length-of-stay in patients undergoing elective open abdominal aortic aneurysm surgery: a retrospective cohort study.
Intraoperative hypothermia in open elective abdominal aortic aneurysm repair may be associated with increased hospital morbidity. This retrospective, single centre study investigated whether there was an association between intraoperative hypothermia in open elective abdominal aortic aneurysm repair and postoperative in-hospital morbidity. The data of 119 patients who underwent open infrarenal abdominal aortic aneurysm repair between January 2006 and January 2011 were collected. ⋯ Intraoperative temperature was not predictive of hospital length-of-stay or any of the other perioperative complications such as acute renal failure, acute respiratory complications, acute myocardial infarction, transfusion requirements or postoperative infection. In the normothermic group, the number of hours in the intensive care unit was 35% lower (ratio of means=0.65; 95% confidence interval 0.51 to 0.84; P=0.0008), even after adjusting for possible confounders such as age, duration of anaesthesia, size of aneurysm, comorbidities and transfusion. Intraoperative hypothermia is a persisting problem and more aggressive warming strategies may need to be identified and employed to achieve normothermia.
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Anaesth Intensive Care · Nov 2013
Observational StudyEffects of prolonged mechanical ventilation with a closed suction system on endotracheal tube resistance and its reversibility by a closed suction cleaning system.
The study objective was to evaluate endotracheal tubes (ETT) from extubated adult patients and compare them to new, unused, size-matched control tubes for changes in inspiratory resistance (Rinsp) and peak inspiratory pressure (PIP) before and immediately after suctioning with the Airway Medix Closed Suction System (AMCSS) (Biovo Technologies, 2013 Tel Aviv, Israel). Sixteen ETTs were recovered from predominantly medical patients who had required intubation and mechanical ventilation for more than 12 hours. ETTs were evaluated within 4.5 hours of extubation. ⋯ Following a single cleaning episode with the AMCSS, Rinsp decreased, regaining an effective ETT ID of a 7.5 to 8 mm tube. A single suctioning episode with this device resulted in a significant reduction in Rinsp, virtually restoring original flow variable values. The AMCSS represents a novel technology in closed suction systems, designed to achieve more effective inner lumen cleaning in prolonged mechanical ventilation.